The advances made in robotics have permitted amplifying their potential fields of application outside of their initial industrial intent. A robot is built with the objective of carrying out tasks that are manual in nature. With the confluence of varying disciplines of technology, such as electronics, engineering, and computing, it can provide support to patients with a diverse set of physical limitations. 1
While the history of these devices spans decades, the progress and evolution of the field of robotics has not lived up to expectations. There are several reasons that justify this stagnation. On the one hand, there is capped functionality when compared to healthy arms and hands, not only due to mechanical limitations or poor strategies of control, but also from the current capabilities of the user to transmit adequate orders to produce the desired movements.
On the other hand, there is aesthetics, which oftentimes runs counter to effective functionality. For example, the noise produced by motors that activate different articulations constitutes a new problem that can limit their use in certain surroundings, or simply be very bothersome for the user. Also, the requirement to have an energy source available for the robot implies that in order to achieve some level of autonomy, portable batteries will need to be carried around by the user. These reasons have led to the search for a compromise between effectiveness, aesthetics, and operational features.
In the field of medicine today, the most prominent applications of robotics include2:
- Telepresence/Surgical Assistance – Allows doctors and surgeons to manipulate surgical instruments from a different location. The practitioner can be in his office somewhere in Australia, while he or she controls robotic limbs in an operating room in the US and performing surgery on a patient.
- Sanitation and disinfection robots – Modern technology has paved the way for many hospitals to improve sanitation by using germ-fighting robots that use UV rays and hydrogen peroxide vapors to sanitize an entire room much quicker.
- Robotic prescription dispensing systems – These are machines store, dispense, mix, label, and count pharmaceuticals. They were designed to add speed and increase customer service by quickly filling out prescriptions, avoiding patient wait times.
- Medical transportation robots – Allows the medical staff to save time by using robots to transport medication and food to patients.
- Rehabilitation robots – The category of which this article will focus the most on, they provide patients with an enhanced quality of life by adding mobility and building patient’s strength to help them rehabilitate from injuries and disabilities, whether temporary or permanent.
Like humans, robots require certain sensory and mechanical abilities in order to perform the functions expected of them. As such, robotic elements are analogous to human parts: brain with computer processor, body with mechanical structure, muscles with motors, and senses with sensors. As such, systems of support can be designed as complete robotic systems, simple mechanisms, automatic, or tele-operational, depending on the needs of the patient.
The most significant decades for putting robotics on the map of medicine occurred in the 1960s and 1970s with the advent of commercially available prosthetic and orthotic robots, such as the Otto Bock hand, Viennatone hand, Hendon arm and the Edinburgh arm.4 Their control was based on myoelectric signals from the patient and auxiliary devices that were adapted to the post-surgical or post-traumatic capacities of the end user.
“Robotics is rapidly entering the future of health care as a tool that will enable more advanced and personalized care for millions of patients. As longevity increases, more people are demanding better rehabilitative care,” said Maryanna Saenko, Lux Research Analyst and lead author of the report titled, ‘Automating the Road to Recovery – How the Rehabilitation Robotics Market Is Changing the Future of Health Care.’ 6
As an assistant or external support, there are already diverse robotic solutions that include domestic and occupational capabilities. For the average person, day to day tasks are plenty and quite varied, and some of them way too complex to be programmed into current industrial robot models. As such, we can’t expect current technology to develop a domestic robot capable of helping a severely handicapped person to perform many tasks. However, robots can be utilized for a number of limited basic functions, such as moving objects, opening a refrigerator, helping a person to drink or eat 7, adjusting an item of clothing, or assisting with personal hygiene, etc.
The application of robotics is very much transferrable to the field of physical rehabilitation. 8 From a practical standpoint, the first problem is coming up with a way to control the mechanical prosthetic. One way to do it is using myoelectric signals of the user that the brain generates to activate muscles. When disability stems from the brain not being able to transmit these signals, other forms of control need to be explored by considering the current physical capacity of the user. Today, home automation, or ‘smart homes’ – systems for the home that can communicate with each other to assist patients by automatizing some tasks – constitute a beneficial possibility for those with different levels of cognitive or physical disability.9 The end goal is the integration of technological advancements into the home with features that promote comfort, security, and convenience while at the same time reducing energy consumption. All indications point to smart homes as an efficient and affordable way to assist the elderly, or anyone that wishes extra assistance in the home for that matter, but especially for the disabled. Smart homes are controlled by one single remote that can control various items and systems found in normal households. For example, sound systems, thermostats, security systems, garage, TVs, curtains, etc. It’s still a new technology and a relatively new market, so the list of devices that are compatible with these systems are continuously growing. 10
The applicable difference between smart homes and prosthetic/orthotic robotics is that the former is statically structured and offers assistance with tasks that are much more repetitive and simpler in nature with little to no environmental factors to consider. Whereas the level of programming and engineering complexity required to instruct limb robots or mobile assistant-type of robots to perform nuanced human movements and activities, is other-worldly. Further, replicating human biology and mechanics still haven’t been mastered by robots because of various challenging problems scientists and engineers face. In so many words, science has not been able to do one better over mother nature. According to Christoph Keplinger, University of Colorado from HASEL Artificial Muscles—Versatile High-Performance Actuators for a New Generation of Life-like Robots:
“Robots today rely on rigid components and electric motors based on metal and magnets, making them heavy, unsafe near humans, expensive and ill-suited for unpredictable environments. Nature, in contrast, makes extensive use of soft materials and has produced organisms that drastically outperform robots in terms of agility, dexterity, and adaptability.” He further states, “One major theme of research is the development of new classes of actuators – a key component of all robotic systems – that replicate the sweeping success of biological muscle, a masterpiece of evolution featuring astonishing all-around actuation performance, the ability to self-heal after damage, and seamless integration with sensing” 11
Still, the outlook is promising for the field of robotics. For example, in 2015, Icelandic lower-leg amputee Gudmundur Olaffsson was the recipient of a bionic ankle that can be controlled with the mind and lower leg by electrical impulses and myoelectric sensors. Bionic limbs used to be the stuff of sci-fi films, but it’s slowly becoming a reality. Although this technology has been in the public conscience for some time, it has done so with the false impression that bionic technology has been mastered, when really, it’s just a few breakthroughs here and there with no consistent level of vanguard pioneering to put bionic robotics at the forefront. Regardless, any advancement tends to stir excitement because it’s only a matter of time before bionic technology becomes a reality. Many lives have changed in parallel to its progress as an emerging technology. But, it has yet to make its way into mainstream application as it’s very expensive and currently too limited in range of application.12
The needs of the user, along with the impossibility of building a robot that can completely compensate for many physical limitations, has led to the development of different types of robotic systems.
Robotic assisted transfer devices (RATD) help the transfer of users from one surface to another. Moving from a wheelchair onto another surface unassisted, and vice versa, presents a statistical risk for the user. According to research led by Grindle and colleagues, “Between 1973 and 1987, 770 wheelchair-related accidents that led to death were reported to the US Consumer Products Safety Commission. 8.1% of these accidents were caused by falls during transfers. Between 1986 and 1990, there were an estimated 36,000 wheelchair-related accidents in the USA that resulted in a visit to the emergency department. 17% of these accidents were due to falls during transfers. In 2003, more than 100,000 wheelchair-related injuries were treated in US emergency departments, showing an upward trend in the number of injuries over time.”14
Not only are RATD beneficial for the patient, but also for the caregivers who normally have to transfer patients manually by lifting them (usually with the aid of someone else). But this puts the caretaker at risk of injury as well since it can be very difficult and exhausting transferring patients in such a way. For this reason, the use of patient lifts is quite popular, although they can be very time consuming to use.
Below are different robot types based on their mobile or stationary nature:
- Robots mounted on wheelchairs15provide the user with the capability to manipulate the environment in different ways. They’re controlled by a joystick that can be actioned with subtle, minor, and effortless movements to accommodate those with severe hand motor issues. Mechanical design requires compactness and adequate length of reach.
- Robots mounted on a fixed base, usually installed next to the user. Most models are relatively simple, affordable, and faster than other systems. 16They are most efficient performing a limited number of simple tasks at high speeds. As such, they aren’t intended for general household use, and they can access only immediate areas.
- Mobile robot systems – Are those that can navigate around the environment autonomously. Their utility as an operative extension of the owner/user is their biggest advantage. Commanding the machine to head to another room and return with medication, water, etc. is a huge advantage that saves time and effort for those at physical risk. To make operating easier, the robot can be preprogrammed with several operational commands, especially those that occur on a daily basis. If someone is an avid reader, for example, they can preprogram the robot to fetch it from the bookshelf using basic commands.
A system of computerized vision that allows locating objects in the environment is still being developed, sparing the user from having to guide the robot towards the target object or area. Most models can move about independently in a typical home environment, and can that way transport objects from one room to another. Their field of application is therefore greater. However, robotic mobile systems can be cost prohibitive, and the low reliability of current systems puts a damper on their true usefulness and efficacy, at least for now. “Because technology is becoming more accessible, price-wise … there is going to be a big leap forward for people who have disabilities. Things are more feasible,” said Kim Adams, a professor at the Faculty of Rehabilitation Medicine in the University of Alberta, where researchers are expanding the realm of possibility for children with disabilities thanks to sophisticated robotic technology. 17
The above types can be further divided into multitaskers and single task manipulators. For example, a robotic arm articulation mounted on a table-like support might be designed specifically and only to feed and provide drink to the user. It consists of a very simple robot arm that has a spoon for a hand, a food tray support, and a glass support. Control is based on actioning the robot to bring the spoon to the user, after filling it from the food tray, to a position close to the mouth (after programming it to do so). Intervals between each spoonful is controlled by the user through an interface that is specific to the residual mobility. A different command brings the glass towards the mouth and inclines it at a proper drinking angle. In this case, the objective isn’t to replace human function, rather, the user can proceed to eat and drink at their own pace with autonomous intent. This solution gives the user the satisfaction to eat by him or herself if they wanted, as well as avoiding fatigue and annoyance towards continued assistance from someone, since this would require a good rapport between assistant and patient.
Technical help is being developed from diverse fields of application. Robotics constitutes just one more step in the development of technological assistance that expands the horizons of many people while improving their quality of life. With the diversity of models continually being introduced along with the inevitable progress of technology, people with disability can count on future advancements to be more accessible and mitigate the impact of their physical or sensory impairment.
1) R.D. Jackson. Robotics and its role in helping disabled people (Engineering Science & Education Journal, 1993) http://digital-library.theiet.org/content/journals/10.1049/esej_19930077
2) Mark Crawford, Top 6 Robotic Applications in Medicine (ASME.org, September 2016) https://www.asme.org/engineering-topics/articles/bioengineering/top-6-robotic-applications-in-medicine
3) Medical Robotic Systems Market Size, Share & Trends Analysis Report By Product (Surgical, Orthopedic, Laparoscopy, Neurological, Rehabilitation, Assistive, Prosthetics, Orthotics, Steerable) And Segment Forecasts, 2012 – 2022 (Grand View Research, 2018) https://www.grandviewresearch.com/industry-analysis/medical-robotic-systems-market
4) Dudley S. Childress, Ph.D. Historical Aspects of Powered Limb Prostheses (Clinical Prosthetics & Orthotics) http://www.oandplibrary.org/cpo/1985_01_002.asp
5) Prosthetic and Therapeutic Robotics to Grow Into $3.6 Billion Market in 2025 (Lux Research, 2016) http://www.marketwired.com/press-release/prosthetic-and-therapeutic-robotics-to-grow-into-36-billion-market-in-2025-2109591.htm
6) Prosthetic and Therapeutic Robotics to Grow Into $3.6 Billion Market in 2025 (Lux Research, 2016) http://www.marketwired.com/press-release/prosthetic-and-therapeutic-robotics-to-grow-into-36-billion-market-in-2025-2109591.htm
7) Robotic exoskeleton allows disabled people to eat or drink by themselves ( Asociacion RUVID, 2018) https://phys.org/news/2018-07-robotic-exoskeleton-disabled-people.html
8) G. Bolmsjo, et al. Robotics in rehabilitation (IEEE Transactions on Rehabilitation Engineering, 1995) https://ieeexplore.ieee.org/document/372896
9) Ali Hussein, et al. Smart Home Design for Disabled People based on Neural Networks (Procedia Computer Science, 2014) https://doi.org/10.1016/j.procs.2014.08.020
10) Ali Hussein, et al. Smart Home Design for Disabled People based on Neural Networks (Procedia Computer Science, 2014) https://doi.org/10.1016/j.procs.2014.08.020
11) Christoff Keplinger, Fall 2018 Campus-wide Robotics Seminar (November 27, 2018) https://robotics.mit.edu/robotics-seminar
12) Erik Sofge, Brain Controlled Bionic Legs are Finally Here. (Popular Science, Online, May 20 2015) https://www.popsci.com/brain-controlled-bionic-legs-are-here-no-really#page-3
13) Executive Summary World Robotics 2018 Service Robots (International Federation of Robotics, 2018) https://ifr.org/downloads/press2018/Executive_Summary_WR_Service_Robots_2018.pdf
14) Garret G. Grindle, Hongwu Wang, Hervens Jeannis, Emily Teodorski, Rory A. Cooper – Design and User Evaluation of a Mounted Robotic Assisted Transfer Device (BioMed Research International, Article ID 198476, July 2014) https://www.hindawi.com/journals/bmri/2015/198476/
15) Marion Hersh. Overcoming Barriers and Increasing Independence – Service Robots for Elderly and Disabled People (International Journal of Advanced Robotic Systems, 2014) http://eprints.gla.ac.uk/101946/1/101946.pdf
16) Marion Hersh. Overcoming Barriers and Increasing Independence – Service Robots for Elderly and Disabled People (International Journal of Advanced Robotic Systems, 2014) http://eprints.gla.ac.uk/101946/1/101946.pdf
17) Clare Clancy. Researchers use robotics to improve mobility for children with physical disabilities (Edmonton Journal, 2016) https://edmontonjournal.com/news/local-news/researchers-use-robotics-to-improve-mobility-for-children-with-physical-disabilities
18) Executive Summary World Robotics 2018 Service Robots (International Federation of Robotics, 2018) https://ifr.org/downloads/press2018/Executive_Summary_WR_Service_Robots_2018.pdf