Robotic medical rehabilitation technology pdf. Medical robotics. Robotics for rehabilitation and prosthetics

Published by: Arkhipov M.V., Golovin V.F., Zhuravlev V.V. Mechatronics, automation, control, No. 8, M., 2011, p. 42-50

Overview of the state of robotics in restorative medicine

1. Classification of medical robots

In order to systematize known and possible robotic systems (RTS) in medicine, a number of classifications have been proposed. The following classification features were used: invasiveness of the procedure, safety, mobility, ergonomics, control as management or diagnostics. One of the classification options, taking into account the latest achievements in medical robotics, is shown in Fig. 1. The main three classes are robots for restorative medicine, robots for life support and robots for surgery, therapy and diagnostics. They represent the main areas of medical robotics, although these classes and their subclasses are not independent in the ways indicated above. Further, in sections 3 - 5, representatives of the subclasses of restorative medicine indicated in the classification are considered.

Fig.1

2. The concept of development and implementation of robots in restorative medicine for healthy people

Restorative medicine is a system of medical activities aimed at diagnosing functional reserves, maintaining and restoring human health through health improvement and medical rehabilitation. Recovery should be understood as a set of preventive measures aimed at restoring reduced functional reserves and adaptive capabilities of the body in practically healthy individuals. The special role of preventive medicine was noted by the Nobel laureate I.P. Pavlov (Fig. 2). In his words: “Preventive medicine achieves its social goals only in the case of a transition from the medicine of pathology to the medicine of the health of the healthy.”

Fig.2

The concept of restorative medicine differs essentially from the concept of medical rehabilitation, which is a set of diagnostic and treatment-and-prophylactic measures aimed at restoring or compensating for impaired functions of the human body and disability in sick people and the disabled.

Rehabilitation is the consolidation of the therapeutic effect in the process of recovery of the patient after an illness. Unlike rehabilitation, which ensures the restoration of health in a sick person, restorative medicine is aimed at reproducing lost health reserves. The therapeutic and health-improving arsenal of restorative medicine provides a person with social and creative activity in his profession, that is, efficiency in the conditions in which his professional activity takes place. Rehabilitation is mainly focused on organ pathology, and accordingly, its criterial apparatus evaluates the degree of return to normal. The methodological tools of restorative medicine are redirected from the search for symptoms of the disease to the assessment of the reserve functional capabilities of the body, specifically to those loads, working conditions in which a person works.

The concept of the development of health care and medical science in the Russian Federation for the period up to 2010 is based on the health-centric model of the health care system developed by the RNCVMiK under the leadership of Academician A.N. Razumov (Fig. 3). The essence of the model is the emphasis on maintaining the health of a healthy person and, consequently, on restorative medicine.

Fig.3

In the future, most of the studies of this monograph will be associated with a contingent of not only injured in military operations, at work, in sports, people with cerebral palsy, post-stroke patients, but also healthy people, tired of physical and mental activity, reducing their working capacity. For example, teachers and university students. It is appropriate to say here about the currently developing system of intensive informatized education, which, in order to increase the effectiveness of education, involves the concentration of efforts of both students and teachers without compromising their health. For them, restorative medicine considered in the monograph is necessary.

Restorative medicine includes a number of therapies, including non-drug ones, one of the types of which is mechanotherapy. Among the many well-known means of mechanotherapy, robotics has the greatest potential.

In 1882, the Russian scientist N.V. Zabludovsky (Fig. 4). “Is it not possible to take advantage of improvements in mechanics for the construction of such machines that would replace the actions of the hands, or would not even the action of machines be preferable to the action of hands? It would be worthwhile to invent a machine, the strength of which could be determined at every moment in numbers and instead of the work of the massager, depending on the subjective muscular feeling, to deal with the work expressed in numbers. In other words, instead of taking the amount of a healing agent by eye, weigh it on an accurate scale.

Fig.4

In those days it was a fantasy, and the scientist only dreamed of the possibility of dosing effects on the hardware of the future. At present, the dreams of the great predictor can be realized by turning to advanced adaptive intelligent robotics. The problem for medicine, first of all, is the development of the concept of N.V. Zabludovsky about a new approach to human physical culture involving not only volitional and passive movements, but also massage. Massage can have both the function of relaxation and mobilization. In the optimal combination of these functions, physical culture can contribute to the preservation and increase of health reserves and increase efficiency in physical and mental labor to a greater extent.

Therefore, the essence of the concept of development and implementation of robots in VM for healthy people is the use of adaptive and intelligent robots in combination with other types of therapies: aroma, melo, psychotherapy to maintain the increase in people's health reserves, increase their performance.

Of course, a robotic system is an automated tool, only temporarily working automatically, obeying a person at the level of making complex decisions and being a reasonable, and not just a physical assistant.

In accordance with the classification proposed above, a review of the state of robotics for restorative medicine was carried out in three areas: manipulations on the joints or movements of the limbs in the joints; manipulations on soft tissues, i.e. various massage; active and biocontrolled prostheses.

3. Robots for performing limb movements in the joints

The movements of the limbs in the joints by the doctor's hands are widely used in sports, restorative medicine, in the treatment and education of patients with the consequences of a stroke, cerebral palsy. Passive and active movements of the limbs in the joints are often performed together with massage, including for recreational purposes. Mechanotherapy replaces the doctor's hands with manipulator hands. One of the first works in which a six-driven manipulation robot was proposed for massage and movement of limbs in the joints appeared in 1997. . Later, single-drive robots from the American company "Biodex", the Swiss company "Con-Trex" and a four-drive robot from the Swiss company "Lokomat" appear.

The robot of the Swiss company “Lokomat” is the most prominent representative of the subclass of rehabilitation robots for performing limb movements in the hip, knee and ankle joints. There is the concept of neuroplasticity, which involves "setting the task of specific learning" and lies in the fact that with the help of repeatedly repeated training, it is possible to improve daily motor activity in patients with neurological disorders. Robotic therapy on the Lokomat complex meets the above requirements and makes it possible to conduct intensive locomotor therapy with feedback. The general view of the complex is shown in fig. 5.

Rice. 5

Lokomat consists of four drives for imposing gait movements and a system for unloading the patient's weight and a treadmill.

Patients in a wheelchair may be without much
labor are transferred to the canvas of the treadmill and fixed with the help of special clamps. The computer controlled drives are synchronized with the speed of the treadmill. They give the patient's legs a trajectory of movement that forms a walk that is close to natural.

Enhanced patient motivation is carried out by controlling the load using biofeedback while displaying the current state on the monitor (Fig. 6).

Rice. 6

For the tasks of orthopedics (adult and children), sports medicine, industrial rehabilitation, prevention and treatment of osteoarthritis, the robot of the American company “Biodex” is known. The principle of operation is based on electronic dynamometry. The system provides fast and accurate diagnosis, treatment and documentation of disorders that cause functional disorders of muscles and joints. The system allows for the mobilization of joints in the direction of flexion / extension, abduction / adduction and rotation, which is necessary for the full restoration of their lost functions.

The package includes a set of devices for working with the hip, knee, shoulder and elbow joints, as well as with the ankle and wrist. A general view of the system working with the upper and lower limbs is shown in fig. 7.

Rice. 7

Robots for upper and lower limb rehabilitation were presented at the Pennsylvania Medical Robotics Symposium. On the left in Fig. 8: GENTLE /s manipulator, developed by the University of Reading, UK; center: ARMguide manipulator, developed by the Rehabilitation Institute of Chicago; right: Manipulandum manipulator, developed by the Rehabilitation Institute of Chicago.

Fig. 8 Manipulators for the restoration of the upper limbs

In Fig. 9, top left: robot AutoAmbulator, developed by HealthSouth, USA; top right: walking simulator, developed by the University of California, USA); bottom left: GaitMaster 2 robot developed by the University of Tsukuba, Japan); lower right: a robot for limb movements, as well as for massage, developed by the Russian Academy of Sciences) described in detail below.

Fig. 9 Robots for the restoration of the joints of the lower extremities

Impacts with the help of the robots discussed above are referred to as mechanotherapy. Mechanotherapy is a method of physical therapy based on the performance of dosed movements (mainly for individual segments of the limbs) performed with the help of special devices. Mechanotherapy is used as a restorative treatment for various movement disorders, when it is necessary to increase the range of motion in the joints and the strength of certain muscle groups. On some devices, you can practice immediately after surgery. The choice of movements performed on mechanotherapeutic devices is determined by the nature of the restriction of movements and the anatomical features of the joint.

Soft tissue manipulation robots (massage robots)

The history of the appearance of robots in the VM for massage is as follows. In 1997, at the second IARP forum on medical robotics, only one work using robotics for restorative medicine was presented - a robot for massage. In 2002, the Tickle massage robot, a tickling insect, appeared on the website of a Dutch company. In 2003, a Russian patent appeared - a robot for plume massage. In 2005, a Silicon Valley website reported on the use of a Puma robot for massage. The idea presented in the Russian work was taken as the basis for this robot. Unfortunately, the development of this development is unknown. The works listed above represent most of the known massage robots, apart from the numerous massage hardware.

A variety of hardware has long been used to facilitate the work of a massage therapist, to prevent occupational diseases of his hands. The simplest of them: vibrators, rollers, nozzles for acupuncture and acupressure are the means of mechanization that the massage therapist moves (Fig. 10).

Fig.10. Restorative medicine hardware

It should be noted that the robot may be a carrier of said hardware.

More complex are automation tools, such as massage chairs. Massage chairs (Fig. 11) as actuators have air cushions with adjustable pressure, rollers with controlled pressing forces. Massage impact zones: neck and shoulder, back, lumbar, buttocks, thighs, legs, feet. Types of massage: kneading, patting, tapping, vibration, Shiatsu. From the control panel, you can set the desired level of massage intensity.

Fig.11

Semi-automatic massage hardware is popular, partially unloading the massage therapist. Figure 12 shows a hand made by the American company Meilis, which helps to perform pressing techniques.

Fig.12

The robot of the Dutch company Tickle is very simple in design (Fig. 13). The metal case contains two electric motors, a rechargeable battery and four sensors that allow you to monitor the slope of the surface on which the massage therapist moves. The movement is carried out with the help of two silicone "caterpillars", covered with protrusions that create a massage effect. The principle of the robot's movement resembles the principle of the tank's movement: each of the motors drives its own caterpillar. The effects of the robot are stroking and tickling, causing a relaxation effect.

Fig.13

The plume massage robot performs flat, continuous, rectilinear stroking on large body surfaces (back, chest, abdomen, limbs). This kind of superficial stroking is distinguished by particularly gentle and light movements that have a calming effect on the nervous system, cause muscle relaxation and improve blood circulation. The design of the robot is a carriage with an electric motor moving along a traverse along the patient's body (Fig. 14). The traverse is profiled according to the relief of the back surface of the nominal patient and cannot be reprogrammed. Stroking brushes hang from the carriage and are pressed against the patient with elastic plates.

Fig.14

In 2007, a facial massage robot WAO-1 (Waseda Asahi Oral Rehabilitation Robot 1) was developed in Japan. The robot (Fig. 15) is equipped with two 50 cm mechanical arms that massage the patient's face from both sides. Safety is ensured by a silometric restrictive system that pushes the robot's arms to the sides, as soon as it applies too much force.
Facial massage is recognized as a very effective way to combat dry mouth, as it stimulates additional salivation, and also helps to correct oral structure disorders.

Rice. fifteen

The effectiveness of massage hardware is determined by the adequacy of mechanical contact with the patient. This contact is made through the hardware tool. Therefore, in techniques that reproduce human hands, the instrument must imitate the contact properties of the human hand: elasticity, warmth, moisture, frictional properties (roughness, smoothness, slipperiness), coordination capabilities (multi-finger, ability to grip). To a greater extent, the listed properties can be provided by a multi-joint manipulation robot.

At the Moscow State Industrial University, a robot has been developed to perform massage techniques and movement of the limbs in the joints. The basis of this robot is the industrial robot RM-01, the manipulating arm of which is anthropomorphic in size and kinematics (Fig. 16). In contact with the body, the robot develops a force of up to 60 N. The necessary forces are developed and controlled by a position-force control system that expands the capabilities of a regular robot.

Fig.16

A six-drive robot with the specified data can perform many well-known manipulations directly on soft tissues, i.e. a variety of massage, as well as manipulations on the joints in the form of passive and active movements of the limbs, post-isometric relaxation in the form of combinations of loading and unloading of the muscles of the limbs. In Fig. 17, the robot performs squeezing out the long muscles of the girl's back.

Fig.17

Active bioguided upper and lower limb prostheses

Bioprosthetics for upper and lower limbs lost as a result of injury or illness relies on simpler solutions. Some of the simplest solutions, to some extent, restore the appearance of the limbs only aesthetically, other solutions restore some functions. Figure 18 shows the classification of prostheses, which highlights the classes of active and biocontrolled prostheses.

Fig.18

Designed based on the theory of ballistic synergies, lower limb prostheses are not active and do not use biosignals, but effectively use the spring resilience of the prostheses.

In traction prostheses of the upper limbs, initially as passive ones, the movements of the grip of the hand were caused by additional movements of the remaining part of the arm or by the movement of the torso. At first, flexible rods were the transmitting link, later active traction prostheses appeared, in which the movements of the rods were reproduced by built-in motors.

Active, but not biocontrolled, are myotonic prostheses, in which the control signals are the efforts of the disabled person. Sensors in the form of microswitches or strain gauges measure these forces and transmit them to the actuators of the hand.

The considered methods of prosthetics without the use of biosignals have a number of disadvantages. Control rods burden the disabled person, make it difficult to move the shoulder girdle, the number of control commands, just like with myotonic control, is limited (one or two commands). Interferences for control are random external shocks into the sleeve of the stump of the prosthesis. However, the simplest prostheses are designed as modular structures and are mass-produced.

The development of biocontrolled prostheses was facilitated by advances in electrophysiology, biomechanics, microelectronics, and adaptive feedback control systems.

At present, the German company “Otto Bock” is known, which mass-produces passive and active prostheses. Figure 19 shows an active knee prosthesis.

Fig.19

The most significant results in bioprosthetics in Russia in the 70-80s are known from the work of the Central Research Institute of PP. In the works of TsNIIPP, a fundamentally new direction in limb prosthetics was born - the creation of prostheses with a bioelectric control system or biocontrolled prostheses. The essence of the new principle of constructing artificial limbs is that the control of external energy sources, due to which the prosthesis works, is basically similar to the natural coordination of movements of a healthy person.

In a living organism, control actions are transmitted to the muscles through bioelectrical impulses that reflect the commands of the central nervous system. Similarly, in a bioelectrically controlled hand prosthesis, the role of command signals is played by biocurrents diverted from the truncated muscles of the stump. The mechanism that executes the commands is an artificial hand, equipped with a small-sized electric drive with autonomous power supply.

Based on the materials of the 2004 symposium in Pennsylvania, active prostheses and exoskeletons are known, shown in Fig.20.

Fig. 20 Active prostheses and exoskeletons

One of the first works in the field of active prostheses and exoskeletons are the works of Miomir Vukobratovic. Under his leadership, exoskeletons were developed, in one version with electric, in the other with pneumatic drives of the hip, knee and ankle joints for both legs of the patient (Fig. 21). The exoskeleton was intended to strengthen the dystrophically weak muscles of the human lower extremities while walking.

Fig.21

The Japanese company Matsushita has developed a robotic suit that will help the rehabilitation of partially paralyzed people (Fig. 22). When a person with paralysis in one arm makes a movement with his healthy arm, the paralyzed arm makes the same movement, tensing and flexing the compressors that act as musculature. By mimicking the movement of a healthy arm, a person in a robotic suit can train their diseased arm until normal functioning of the limb is restored.

Fig.22

The costume weighs 1.8 kg. It was developed jointly by

The suit has been tested in a hospital and is planned to be commercialized. The approximate cost of a suit for use in rehabilitation clinics is $17,000, and for home use, about $2,000.

Another Tokyo-based company, Cyberdine, has developed an automated HAL (Hybrid Assistive Limb) suit (Figure 23) that helps the elderly and people with walking disabilities. The sensor device will be available in Japan for a monthly rental of $2,200. A 22-pound battery operated computer system is attached to the waist. It operates braced drives that are strapped to the hips and knees and provide automated walking assistance.

Fig.23

conclusions

1. Judging by the publications of development organizations and medical centers, the areas of application of medical robots, including for restorative medicine, are expanding and the demand for them is increasing.

2. Medical robots in comparison with other hardware have a number of advantages. These are fast reprogrammability, high accuracy of repetition of movements, tirelessness, absence of subjective factors (conscientiousness), friendly interface (psycho-emotional contact), partnership (for children, involvement in games, in various movements, for example, in morning exercises). Also, adaptation to the individual characteristics of a person (positional-force control), the presence of intelligence (accumulation of experience, analysis, generation of programs), increased security due to adaptation and intelligence.

3. Compared to the hands of a doctor, medical robots of today are often inferior in sensitivity and coordination in complex movements.

4. The concept of developing and implementing robots in VMs for healthy people is to use adaptive and intelligent robots to maintain and increase the health of the population, restore the working capacity of workers.

5. When developing and implementing robots in VMs, a compromise should be made between multifunctional robots and economical specialized ones with a small number of drives.

6. For the developed CM hardware, including robots manipulating soft tissues and joints, active and biocontrolled prostheses, tactile and silometric information is effectively used, both for open-loop and closed-loop force and position-force control systems.

7.Bioinformation is used directly as control signals, forms closed systems or forms biological feedback through the vision and human nervous system.

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Department of Robotic Methods of Medical Rehabilitation is a division of the Center for Medical Rehabilitation and Restorative Medicine.

Domestic and foreign technologies for restorative treatment and rehabilitation are introduced into the work of the department, harmoniously combining classic proven methods and modern scientific achievements.

The main direction of the department's work is restorative treatment and rehabilitation after cerebrovascular accident, craniocerebral injuries, lesions of the musculoskeletal system.

The availability of high-tech rehabilitation equipment with biofeedback makes it possible to assess the functional reserves of the body and draw up an individual treatment program for each patient.

Complex Biodex Systems 4 PRO is a leader in neuromuscular testing and rehabilitation exercises. The combination of dynamic and static muscle loads, the ability to mobilize the joints in various directions allows for the full restoration of lost motor functions.

Applications: orthopedics, neurology, traumatology, sports medicine, occupational rehabilitation, gerontology.

The complex provides fast and accurate diagnosis, treatment and documentation of disorders that cause functional disorders of the joints and muscles. The kit includes a set of devices for working with the hip, knee, shoulder, elbow, ankle and wrist joints.

The Biodex Systems 4 system gives complete freedom in the choice of treatment regimens at various clinical stages, which allows you to individually approach the problems of each patient.

Robotic rehabilitation complex Lokomat is used to restore walking skills in patients with severe motor deficit due to craniocerebral and spinal injuries, the consequences of cerebrovascular accident.

Robotic orthoses are precisely synchronized with the speed of the treadmill and set the patient's legs in a trajectory that forms a walk close to physiological. The user-friendly computer interface allows the clinician to control the device and adjust the training parameters according to the capabilities and needs of each patient. The integrated feedback system visually illustrates gait parameters in real time.

Robotic orthosis Armeo allows you to increase the efficiency of restoring the function of the upper limbs, impaired due to craniocerebral and spinal injuries, multiple sclerosis, cerebrovascular accident; after surgical removal of tumors of the brain and spinal cord; with post-traumatic neuropathy.

Classes on Armeo make it possible to prevent a threatening loss of muscle strength and the development of joint contracture, help reduce spasticity, improve coordination, and teach new movements. Armeo allows patients with hemiparesis, using the residual functionality of the injured limb, to develop and enhance locomotor and grasping functions. The computer program contains a wide range of effective and entertaining video games with different levels of difficulty. The device is equipped with a biofeedback function.

THERA-VITAL- a simulator for the rehabilitation of the upper and lower limbs in active-passive mode. Applicable:

in neurology (stroke, TBI, spinal injury, Parkinson's disease, cerebral palsy);
traumatology-orthopedics (condition after prolonged immobilization, after endoprosthetics);
in cardiac rehabilitation;
gerontology (decrease in movement deficit in elderly and senile people);
to reduce the consequences of a lack of motor activity (edema, joint contractures);
in order to prevent complications in patients of different ages with reduced motor activity.

Rehabilitation simulator Kinetec Centura used for permanent passive development of the shoulder joint in order to prevent joint stiffness, soft tissue contracture and muscle atrophy.

With the use of the simulator, stiffness of the shoulder joint is prevented, the process of postoperative restoration of the range of motion is accelerated, the quality of the articular surface is improved, pain and swelling are reduced.

Indications for use: rotator cuff surgery, total shoulder replacement, frozen shoulder, fractures and dislocations requiring reconstructive surgery on the clavicle, scapula, arthrotomy, acromioplasty, burns, rehabilitation after mastectomy.

BTE TECHNOLOGIES (TECH TRAINER, PRIMUS RS) - universal complexes for functional assessment, diagnosis and rehabilitation of the musculoskeletal system. Includes a large number of adapters and attachments to simulate various professional and everyday activities (both isolated and complex movements). They allow training in all motor planes. The touch screen and user-friendly software interface makes testing and training much easier. Test and training data is stored and documented.

Applications: industrial and sports rehabilitation, orthopedics, neurorehabilitation, strength testing.

Non-contact hydromassage on devices "Medistream», « Medy Jet»

Hydromassage has been recommended for more than 20 years by doctors and professional athletes for relief and pain relief. Powerful waves of warm water cover the entire body, giving the body a deep relaxing and revitalizing massage. The non-contact hydromassage procedure relieves pain, relieves muscle tension, improves blood circulation in the massaged area, relieves stress and anxiety.

Alpha capsule- this is the effect of mechanotherapeutic, thermotherapeutic and phototherapeutic factors: general vibrotherapy, systemic and local thermotherapy, pulsed photostimulation and selective chromotherapy, audio relaxation, aromatherapy, aeroinotherapy. Alpha-massage, carried out in a capsule, improves the mood of patients, reduces internal tension, significantly increases the increase in exercise tolerance and stabilizes the vegetative status.

Indications for procedures in the Alpha capsule: overweight; local fat deposits; cellulite; decreased turgor and skin tone; cleansing and detoxification of the body, emotional stress, sleep disorders; neuroses; chronic fatigue; hypertonic disease; headache; reduced immunity; rehabilitation after sports injuries; consequences of long-term illnesses.

Apparatus for pneumocompression of the lower extremitiesPULSTAR s2

Currently, pneumocompression is the main method used for the prevention and treatment of various chronic vascular diseases of the extremities.

Pneumatic compression is a method of active functional therapy, where dosed physical activity is used as a therapeutic factor - squeezing the limbs. Pneumomassage procedures improve peripheral circulation, accelerate blood flow, develop a collateral bed, reduce vasospasm, and improve tissue trophism.

Indications for use: local edematous syndromes in venous insufficiency and lymphostasis; obliterating diseases of the lower extremities; removal of fatigue and restoration of working capacity after prolonged physical exertion, forced physical inactivity; in order to prevent vascular diseases of the limbs in persons who are on their feet for a long time due to the nature of their activity; with postmastectomy edema of the upper extremities.

Multifunction massage bed Nugabest combines various methods of healing: reflexology, manual therapy, physiotherapy, low-frequency myostimulation.

The combination in one product of various methods of influencing the body allows for effective prevention and rehabilitation of a wide range of diseases:

musculoskeletal system (diseases of the spine);
trophic disorders of neurogenic and vascular origin;
peripheral nervous system (radiculitis);
situational stressful situations (nervous fatigue);
chronic fatigue syndrome and physical overwork;
posture correction in adolescence and youth;
in gynecology and urology.

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Equipment for rehabilitation in our company

Devices for rehabilitation and physiotherapy, sports and aesthetic medicine. Multifunctional simulators based on electrical, ultrasonic, laser, magnetic, micro- and short-wave effects are used to improve microcirculation, tissue regeneration and trophism. Robotic upright beds, sensory treadmills, strength and cardio machines have many settings and easily adapt to the physiological characteristics of each patient.
Hydrotherapeutic and balneological equipment. Showers and baths with the option of hydromassage, baths based on mud, mineral and thermal waters provide effective therapeutic and spa treatments.
stabilometric systems. Simulators with biofeedback on the support reaction contribute to the restoration of motor activity of bedridden, partially immobilized and outpatients.
Equipment for shock wave therapy. Devices for generating acoustic waves are equipped with a wide range of applicators and nozzles that target problem areas of patients with urological, neurological, orthopedic and other diseases.
urodynamic systems. Fully computerized equipment provides effective pelvic floor muscle training. Saving session data helps track the progress of each patient's recovery.

Rehabilitation of patients after injuries and strokes is a multi-stage process that takes place over a long period of time and includes many components (ergotherapy, kinesiotherapy, massage courses, exercise therapy, sessions with a psychologist, speech therapist, treatment by a neuropathologist).
In modern medicine, new methods are emerging that serve to restore the functioning of the brain and return the patient to normal life as soon as possible.

Robotic mechanotherapy - a new method of rehabilitation

Robotic mechanotherapy is one of the newest directions in restoring the patient's motor functions. Its essence lies in the use of special robotic structures for training the functions of the upper and lower extremities with the presence of feedback.

The advantage of robotic therapy is the achievement of the best quality of training compared to traditional physical therapy due to the following factors:

increase in the duration of classes;
high accuracy of cyclic repetitive movements;
unchanging uniform training program;
the presence of mechanisms for evaluating the effectiveness of the exercises performed and the ability to show it to the patient.

1. System for the rehabilitation of the upper limbs.

This type of device is designed to restore the function of the hands and fingers, mainly in cases of strokes and craniocerebral injuries, and it is also possible to carry out rehabilitation programs for post-traumatic and postoperative pathologies of the joints of the hands, chronic degenerative and inflammatory diseases of the joints of the hands. The essence of the system is in the technique of reverse training of the movements of the upper limbs.

In case of injury or in the area of damage to the brain tissue, the cells die, and the transmission of impulses stops in this area of the brain. However, thanks to the mechanism of neuroplasticity, the brain can adapt to many pathological situations.

Neuroplasticity is the ability of healthy neurons that are located near the focus of brain tissue damage to connect with surrounding nerve cells and take on certain functions, that is, under certain conditions (for example, receiving stimuli from the periphery) to restore information transmission between the central and peripheral nervous system.

Therefore, a very important factor is the program of the effects of certain stimuli on the affected area of the brain. Such stimuli are repetitive functional movements that must be performed very precisely in a certain order.

Training on robotic rehabilitation simulators can provide a similar incentive program. The device can perform from three hundred to five hundred high-precision repetitive movements per hour (compared to thirty to forty movements during normal training), which creates optimal conditions for the restoration of hand functions in a shorter time.

The course of therapy can be taken in the hospital daily, or on an outpatient basis - then the course is carried out hourly two to three times a week.

2. Robotic complexes for teaching the skill of walking.

These designs are a breakthrough in robotics and are designed to treat pathological conditions with impaired gait, coordination and balance functions.

Indications for use are movement disorders of the lower extremities associated with the presence of a craniocerebral or spinal injury, the consequences of a stroke, parkinsonism, multiple sclerosis and demyelinating diseases.

The whole apparatus may include an automatic gait synchronization platform, a patient body suspension system, an automatic leg movement system, and a computer program. By monitoring and regulating the movements of the patient with the help of sensors, stimulation of the affected areas of the brain is achieved in the same way as it happens during natural walking. .

The use of such recovery systems allows you to:

help the patient to stand up and restore the function of walking in the shortest possible time;
prevent complications associated with immobility of patients for a long time (pressure sores, muscle atrophy, congestion in the lungs);
adapt the patient's heart and blood vessels to return to physical activity and the vertical position of the body.

The course of therapy can last from fifteen to forty-five workouts. Their number is determined individually for each patient by the attending physician after a clinical examination.

Types of robotic complexes

As clinical practice shows, restoring the motor activity of patients with the help of robotic mechanotherapy in most cases helps to avoid disability and return patients to normal life.

You can take a course of robotic mechanotherapy using the latest rehabilitation systems at Evexia Medical Clinic. These revolutionary methods of recovery allow you to program your personal program for each patient, depending on the needs and capabilities of the patient.