The Rehabilitation and the Robotics: Are They Going Together Well?

Exploring the Impact of Socially Assistive Robots in Rehabilitation Scenarios

BACKGROUND

Socially Assistive Robots (SARs) represent an innovative approach in rehabilitation technology, significantly enhancing the support and motivation for individuals across diverse rehabilitation settings. Despite their growing utilization, especially in stroke recovery and pediatric rehabilitation, their potential in musculoskeletal and orthopedic rehabilitation remains largely underexplored. Although there is methodological and outcome variability across the included studies, this review aims to critically evaluate and summarize the research on SARs in rehabilitation, providing a thorough overview of the current evidence and practical applications.

METHODS

A comprehensive search was conducted across multiple databases, resulting in the selection of 20 studies for analysis. The reviewed papers were categorized into three main classes based on the roles of the robots in rehabilitation: Motivation, Imitation, and Feedback Providers.

RESULTS

The analysis highlights that SARs significantly improve adherence to rehabilitation programs, enhance motor function, and increase motivation across clinical and home settings. Robots such as NAO, Pepper, and ZORA demonstrated high efficacy, particularly in stroke recovery and pediatric rehabilitation.

CONCLUSIONS

SARs offer transformative benefits in rehabilitation, providing scalable, personalized solutions through motivational support, guided exercises, and real-time feedback. Their integration into orthopedic rehabilitation could address critical clinical needs, enhancing precision in exercises, adherence to long-term programs, and overall patient outcomes. Future research should prioritize the development and validation of SAR-based interventions for musculoskeletal disorders to unlock their full potential in this domain.

The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches

Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

BACKGROUND

This article presents the system architecture and validation of the NeuroSuitUp body-machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke.

METHODS

The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires.

RESULTS

Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported.

CONCLUSIONS

Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness.

Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients

BACKGROUND

In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases.

METHODS

A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized.

RESULTS

The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables.

CONCLUSIONS

Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.

Comment on Anwer et al. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare 2022, 10, 190

We are writing to you as the corresponding author of the interesting review study entitled "Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies" [...].

Ethics and Automated Systems in the Health Domain: Design and Submission of a Survey on Rehabilitation and Assistance Robotics to Collect Insiders’ Opinions and Perception

Background: The problem of the relationship between ethics and robotics is very broad, has important implications, and has two large areas of impact: the first is conduct in research, development, and use in general. The second is the implication of the programming of machine ethics. Purpose: Develop and administer a survey of professionals in the health domain collection of their positions on ethics in rehabilitation and assistance robotics. Methods: An electronic survey was designed using Microsoft Forms and submitted to 155 professionals in the health domain (age between 23 and 64 years; 78 males, mean age 43.7, minimum age 24, maximum age 64; 77 females, mean age 44.3, minimum age 23, maximum age 64) using social media. Results and discussion: The outcome returned: (a) the position on ethics training during university studies and in the world of work, (b) the organizational aspects hindered by ethics and those to be perfected in relation to ethics, (c) issues of ethical concern, (d) structured feedback on the usefulness of the methodology along with considerations of open text. Conclusions: An electronic survey methodology has allowed the structured collection of information on positions towards ethics in this sector. Encouraging feedback from the participants suggests the continuation of the study is beneficial. A continuation is expected, expanding the audience of professionals involved and perfecting the survey with the support of scientific companies.

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective

BACKGROUND

The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.

METHODS

A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.

RESULTS

Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.

CONCLUSIONS

Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.

TRIAL REGISTRATION

PROSPERO registration ref. CRD42021224141 .

Information Security in Medical Robotics: A Survey on the Level of Training, Awareness and Use of the Physiotherapist

Cybersecurity is becoming an increasingly important aspect to investigate for the adoption and use of care robots, in term of both patients' safety, and the availability, integrity and privacy of their data. This study focuses on opinions about cybersecurity relevance and related skills for physiotherapists involved in rehabilitation and assistance thanks to the aid of robotics. The goal was to investigate the awareness among insiders about some facets of cybersecurity concerning human-robot interactions. We designed an electronic questionnaire and submitted it to a relevant sample of physiotherapists. The questionnaire allowed us to collect data related to: (i) use of robots and its relationship with cybersecurity in the context of physiotherapy; (ii) training in cybersecurity and robotics for the insiders; (iii) insiders' self-assessment on cybersecurity and robotics in some usage scenarios, and (iv) their experiences of cyber-attacks in this area and proposals for improvement. Besides contributing some specific statistics, the study highlights the importance of both acculturation processes in this field and monitoring initiatives based on surveys. The study exposes direct suggestions for continuation of these types of investigations in the context of scientific societies operating in the rehabilitation and assistance robotics. The study also shows the need to stimulate similar initiatives in other sectors of medical robotics (robotic surgery, care and socially assistive robots, rehabilitation systems, training for health and care workers) involving insiders.

The Social Robot and the Digital Physiotherapist: Are We Ready for the Team Play?

Motivation: We are witnessing two phenomena. The first is that the physiotherapist is increasingly becoming a figure that must interact with Digital Health. On the other hand, social robots through research are improving more and more in the aspects of social interaction thanks also to artificial intelligence and becoming useful in rehabilitation processes. It begins to become strategic to investigate the intersections between these two phenomena. Objective: Therefore, we set ourselves the goal of investigating the consensus and opinion of physiotherapists around the introduction of social robots in clinical practice both in rehabilitation and assistance. Procedure: An electronic survey has been developed focused on social robot-based rehabilitation and assistance and has been submitted to subjects focused on physiotherapy sciences to investigate their opinion and their level of consent regarding the use of the social robot in rehabilitation and assistance. Two samples of subjects were recruited: the first group (156 participating subjects, 79 males, 77 females, mean age 24.3 years) was in the training phase, and the second (167 participating subjects, 86 males, 81 females, mean age 42.4 years) group was involved in the work processes. An electronic feedback form was also submitted to investigate the acceptance of the proposed methodology. Results: The survey showed a consistency of the results between the two samples from which interesting considerations emerge. Contrary to stereotypes that report how AI-based devices put jobs at risk, physiotherapists are not afraid of these devices. The subjects involved in the study believe the following: (a) social robots can be reliable co-workers but will remain a complementary device; (b) their role will be of the utmost importance as an operational manager in their use and in performance monitoring; (c) these devices will allow an increase in working capacity and facilitate integration. All those involved in the study believe that the proposed electronic survey has proved to be a useful and effective tool that can be useful as a periodic monitoring tool and useful for scientific societies. Conclusions: The evolution of social robots represents an unstoppable process as does the increase in the aging of the population. Stakeholders must not look with suspicion toward these devices, which can represent an important resource, but rather invest in monitoring and consensus training initiatives.

The Social Robot in Rehabilitation and Assistance: What Is the Future?

This commentary aims to address the field of social robots both in terms of the global situation and research perspectives. It has four polarities. First, it revisits the evolutions in robotics, which, starting from collaborative robotics, has led to the diffusion of social robots. Second, it illustrates the main fields in the employment of social robots in rehabilitation and assistance in the elderly and handicapped and in further emerging sectors. Third, it takes a look at the future directions of the research development both in terms of clinical and technological aspects. Fourth, it discusses the opportunities and limits, starting from the development and clinical use of social robots during the COVID-19 pandemic to the increase of ethical discussion on their use.