Workshop: Towards the standardization of robot/machine-aided stroke rehabilitation and assessment

Organizers name(s), affiliation(s)

Rui Loureiro, Senior Research Fellow, The University of Reading, UK

Michelle Johnson, Assistant Professor, Medical College Wisconsin, USA

James Patton, Associate Professor, The University of Illinois, USA

William Harwin, Professor, The University of Reading, UK

 

Statement of objectives

This workshop builds on the results of the stroke workshop organized at ICORR'07. One of the outcomes of the ICORR'07 workshop was the need to standardize robot-aided stroke rehabilitation and assessment methodologies.

 

Over the past decade a growing interest in stroke rehabilitation resulted in the development of several interesting robotic systems. Although a number of very exciting ideas found their way to commercialization, the slow uptake of technology seem to be associated (among other factors) with the need to make technology transparent to the user.  Besides the technological push, we now face the challenge of making such technology meaningful to the clinicians and patientsf needs. One major factor influencing technology acceptance is the growing number of different approaches introduced by various research groups and the variability of results available. There is a need for a unified framework which can be used regardless of technology form. The development of such a framework would be a critical step forward in the field bringing us closer to making robotic rehabilitation technology widely understood and accepted as a useful tool.

 

ICORR 2009 provides the right backdrop for the development of this unified evaluation framework. Our workshop goals are to discuss this topic and to attempt to form an international scientific committee to drive the development of a unified framework. It is envisaged that the outcome of this workshop will fuel collaborative work for the next two years and publication of the first set of guidelines for a standardized robotic therapy and assessment framework at ICORR 2011.

 

The outcomes of the workshop will be posted on a dedicated wiki which will be managed by the scientific steering committee for the exchange of ideas and contributions towards the guidelines for the unified framework.    

 

Intended audience, and their estimated number

This half-day workshop will be driven by invited experts who will actively discuss, generate ideas (roadmap/plan) and identify an international steering scientific committee to put those ideas into practice. Although a list of experts has been identified, the workshop is open to all attending ICORR.

 

This workshop is intended for researchers, engineers, medical professionals, commercial institutions and user groups working in the field of stroke rehabilitation.

 

List of speakers, topics and approximate time

a)       A small number of invited speakers to give a talk about a specific topic, such that discussions can be stimulated and groups formed to generate ideas/roadmap.

b)       The workshop organizers will prepare a number of topics for discussion (see table below), form groups to discuss each topic and assign a moderator to each group. The moderators (breakout leaders) together with the organizers will be responsible for preparing the topic questions. In addition each moderator(s) will present a short overview of the topic and steer the discussions driven from a set of questions.

 

A tentative agenda is illustrated below.

 

 

 

 

time

topic

content

speaker

13:00

Registration

Choose breakout session to participate

-

14:00

Welcome

Rational for workshop and aims

Organizers

14:15

Factors governing the use of novel robotic technology

for the assessment and treatment of neurological disorders

Overview of traditional rehabilitation process, diagnosis and assessment of strokes

 

Prof. William Zev Rymer

 

14:45

Questions and answers

 

ALL

14:50

Neurorehabilitation robotics: from the scientific idea to

clinical application and commercial use

Literature review of current rehab robots for UL and LL. Issues and challenges in making technology available and meaningful to the users (health services, clinicians and patients)

 

 

Prof. Robert Riener

15:20

Questions and answers

 

ALL

15:25

Why we may not be ready for standardization

Motives to seek/postpone stroke rehabilitation and assessment exercise guidelines.

 

Prof. H. Igo Krebs

15:55

Questions and answers

 

ALL

16:00

Coffee break

-

-

16:15

General open discussion

 

ALL

16:30

Breakout sessions

Summarize field, identify problems, where headed and suggestions,  practice guidelines, goals for the next 5-10 years

 

 

B.1

Upper extremity therapy

Moderators:

F. Amirabdollahian; E. Burdet; K. Nagai

 

B.2

Lower extremity therapy

Moderators:

R. Riener; S. Scott; L. Zhang

 

 

B.3

Engineering/clinical assessment and diagnosis

Moderators:

A. Toth ; W. Rymer; G. Fazekas

 

B.4

Psychological issues (motivation)

J. Van Vaerenbergh; J. Burridge; W. Harwin

 

B.5

Barriers to technology transfer

Moderators:

G. Colombo; H.I. Krebs; J. Hidler

17:00

Breakout summaries

Summary of issues and recommendations

Breakout Leaders

17:30

Open discussion

 

ALL

17:45

After workshop plan

Formation of international scientific steering committee to work on standardization issues.

Organizers

18:00

Adjourn

 

 

 

 

Speaker 1: William Zev Rymer MD PhD, Rehabilitation Institute of Chicago, USA

 

Factors governing the use of novel robotic technology

for the assessment and treatment of neurological disorders

The central issue limiting widespread use of robotic devices in the treatment of chronic neurological disorders is the lack of a coherent theoretical framework for their use.

Although our premise for robotics has been that the robot should emulate the actions of the therapist, it is currently unclear how to characterize the actions of the therapist rigorously, and to determine which of these actions are important to emulate.  Furthermore, we don't know whether the robotic devices should act to reduce error, or to increase it for upper extremity motion. Conversely we don't know whether trajectory control is important in gait recovery. These difficulties will be discussed and a framework offered for addressing these concerns.

 

Speaker 2: Robert Riener PhD, ETH Zurich and University Hospital Balgrist, Switzerland

 

Neurorehabilitation robotics: from the scientific idea to

clinical application and commercial use

Robots can serve to assist and evaluate the rehabilitation of upper and lower extremity movement functions. This presentation first provides an overview of existing robotic devices and strategies that can support the movement therapy of the upper and lower extremities in subjects with neurological disorders. This includes an explanation of so-called patient-cooperative controllers that take into account the patientfs intention and efforts rather than imposing any predefined movement. Such cooperative robotic approaches can improve patient motivation and the quality of the therapy compared to conventional approaches. Furthermore, audiovisual displays can be used to present a virtual environment and let the patient perform game-like tasks and activities of daily living. Such virtual reality enhanced approaches can further increase patient motivation, thus, improving therapeutic compliance and intensifying the training performed. Additionally, the robots can also provide quantitative measures for the assessment of the rehabilitation process.

In the second part also relevant methodical and organizational steps will be presented when developing a robotic therapy device and transferring it for clinical and commercial use. This includes insights into the close interdisciplinary interactions among engineers, physicians, therapists and industrial partners and their common efforts through the phases of concept design, setting up a first lab version, tests on subjects, and manufacturing of a prototype as well as approval by ethical and technical inspection agencies, pilot clinical testings, and performance of clinical trails as well as the protection of intellectual property and negotiations with industrial parties.

 

Speaker 3: H. I. Krebs PhD,  Massachusetts Institute of Technology, USA

 

Why we may not be ready for standardization

 

While the history of the car industry might be traced to 1769 and perhaps even earlier, it was the introduction of the Benzf gasoline internal combustion engine in 1885 that sparked a dazzling growth of the industry with literally hundreds of companies producing a multitude of vehicles in the next 20 years. As the product and market matured, companies were decimated following 1929 (Great Depression); only a handful of gsurvivorsh passed through an intense process of standardization with perhaps more to come in the very near future.

From this historical perspective, one might discuss whether rehabilitation robotics is ready for standardization or on the contrary, as I will articulate, is at a point closer to the incipient phase of the automotive industry. I will argue that we yet have to understand what constitutes the best therapy, how to tailor it to a particular patientfs needs, and how to quantify it. It is too early to forge attempts to control original thinking and new ideas especially since, in the best example of a gcatch-22,h engineers, neuroscientist, and clinicians will only answer these questions while probing forward. gCowboysh and innovators are still welcome in rehabilitation robotics. Barbed wire and fences will be laid down when we know the answers.

Scientific Committee

Europe

Andras Toth, Budapest University of Technology and Economics, Hungary

Etienne Burdet, Imperial College London, UK

Farshid Amirabdollahian, Hertfordshire University, UK

Gabor Fazekas, National Institute for Medical Rehabilitation, Hungary

Gery Colombo, Hocoma, Switzerland

Jane Burridge, Southampton University, UK

Jo Van Vaerenbergh, Katholieke Universiteit Leuven, Belgium

Lorenzo Masia, IIT, Italy

Marko Munih, Ljubljana University, Slovenia

Robert Riener, ETH Zurich, Switzerland

Rui Loureiro, The University of Reading, UK

William Harwin, The University of Reading, UK

Japan

Akio Inoue, ER Tec Co. Ltd, Japan

Futoshi Wada, University of Occupation and Environmental Health, Japan

Junji Furusho, Osaka University, Japan

Kengo Ohnishi, Okayama Prefectural University, Japan

Kiyoshi Nagai, Ritsumeikan University, Japan

Kunihiko Oda, Osaka Electro-Communication University, Japan

Noriyuki Tejima, Ritsumeikan University, Japan

Seiichi Takarabe, Information Technology Development JAPAN INC, Japan

Takuya Ozawa, Social Medical Corporation Kyowakai, Kano general hospital, Japan

North America

Adriana Tapus, University of Southern California, USA.

Allison  Okamura, John Hopkins University, USA

Hermano Igo Krebs, MIT, USA

James Patton, The University of Illinois, USA

Joe Hidler, National Rehabilitation Hospital, Washington DC, USA

Larry Zhang, Rehabililation Institute of Chicago, USA

Michelle Johnson, Medical College Wisconsin, USA

Rajiv Dubey, University of South Florida, USA

Steve Scott, Queens University, Canada

Tobias   Nef, The Catholic University of America, USA

W. Zev  Rymer,  Rehabilitation Institute of Chicago, USA