By Libing Gu, Head of Academic Relations
It is estimated that by 2050 the world population aged over 65 will triple from 6.9% to 20%. While longevity is an important achievement of modern day, it does present challenges in terms of caring for an increasingly frail older population. On September 13, 2021, in the third edition of the nexFrontier series, we invited experts from NCCR Robotics, EPFL, ETH Zurich and Shanghai Jiao Tong University to introduce a wide variety of emerging robotic technologies and products that are being developed to meet the challenges of ageing societies.
To start with, Professor Pierre Dillenbourg, Associate Vice-President for Education at EPFL, Core PI at NCCR Robotics presented to us the palm-size Cellulo, a robot initially designed for school and then used for the gamification of rehabilitation activities for stroke patients. Traditionally, the rehabilitation training for stroke patients includes monotonous activities like table-cleaning and as a result, only 30% of the patients are committed. Iteratively co-designed with neurologists, therapists and patients, Cellulo motivates stroke patients effectively in their rehabilitation. A typical exam is a physical Pacman game: a player moves the robot to collect fruits in a maze while two other robots (ghosts) try to catch him. The complexity of the maze, the speed and number of ghosts and their strategies can be adapted to the level of the player.
The research results show that less impaired patients benefit more than those who are more impaired, paving the road for the project of “Silver Haptic”, which consists of the development of a variety of games for elderly at home, in elderly center of the community or nursing home to practice motor, cognitive and social skills. These games could be played either alone or with family or therapists in presence or at distance. Other key advantages include adaptivity empowered by real-time data collection as well as low cost compared to most of the medical technologies.
Secondly, Professor Guang-Zhong Yang, Chair Professor, Dean of the Institute of Medical Robotics, Shanghai Jiao Tong University, Editor-in-Chief, Science Robotics, discussed the role of robotics for the ageing society and how surgical, assistive and rehabilitation robots will be used in future years. Under the global healthcare trends, there are many issues resulting from ageing population such as dementia, cardiovascular diseases and chronic diseases, to name a few. Robotic technologies are needed to develop their prevention (e.g. imaging), diagnosis (e.g. sensing), treatment (e.g. minimum invasive technique) and evaluation (e.g. rehabilitation devices). Besides, ageing body requires assistance for its brain and nervous system, respiratory system, musculoskeletal system as well as visual and sensory system. Wearable and implantable devices are widely used in clinical care to enhance the sensory feedback, motor function and the independence of these aged people. In terms of robotics, one of the areas that a large number of research have been dedicated to is robotic surgery. For octogenarians, the trauma one can experience due to surgery is very limited. Using minimum invasive means allows us to perform a surgery otherwise too challenging or too risky for the aged group. Many platforms have been thus developed for neuro/ENT, laparoscopic, orthopaedic and endoluminal surgery.
Prof. Yang gave an illustration of a joint replacement surgery. In this platform where his team was involved, the robotic system was integrated into the surgical workflow very well, reducing effectively the complication and increasing accuracy and consistency. There are more different techniques currently developed by research institutions and commercial organizations, such as upper and lower exoskeletons to enhance musculoskeletal functions. In terms of technological trend, more and more devices are moving towards soft exoskeleton system because of its safety and low cost. Another fast-growing area is EMG/EEG based human-robot interaction, which allows more active assistance that can be used in practice. Many commercial platforms are already on the market (Armeo, Ekso, Gypsy, Lokomat), including many systems developed by Swiss companies and research groups.
Prof. Yang stressed that robots are not just providing physical support, it is even more important to create a system that ensures seamless robot-human integration. In this respect, there are many new developments reported in Science Robotics for which Prof. Yang is the Founding Editor. For instance, the biomimetic sensory feedback through peripheral nerve stimulation improves dexterous use of bionic hand, allowing us to manipulate more complex, soft and delicate objects. This is the general direction the research community is driving towards, partially due to the advances in material science, the sensor integration as well as the ability in terms of modelling.
Prof. Guang-Zhong Yang draw the conclusion that the future development of robots for elderly care will be based on the principle of “4Cs (compliant, continuum, cooperative, cognitive)” and the research focus will be pushing the levels of autonomy of surgical robots towards level 2 and the one of assistive robots towards level 4 or 5.
Subsequently, Professor Robert Riener, Co-Director of NCCR Robotics, Full Professor at ETH Zurich and University Hospital Balgrist, University of Zurich presented in his talk new patient-cooperative and easy-to-use robotic devices that improve the rehabilitation of arm movements and gait. Prof. Riener underlined that robots can be very useful to restore movement abilities of upper and lower limbs. First, they can promote neuro-rehabilitation as training devices after neurological injuries such as spinal cord injury (SCI), traumatic brain injury and stroke. Taking stroke for example, every year there are 16 million new cases worldwide and more than 90% of the time, these patients are lying in bed and the time which could be used for therapy is very limited. As higher intensity of training leads to better rehabilitation outcome, Prof. Riener’s lab developed an arm therapy robot called ARMin, which is the 1st exoskeleton applied to the therapy of stroke patients. To increase patient compliance, a path controller was implemented in ARMin III where the robot behaves assistive, corrective when needed, supports and does not restrict the patient. The same path controller was also adopted in Lokomat for gait training.
Evidences show that the combination of physical activity and cognitive activity will enhance the neuro-plastic effects, bringing a better quality of life for the patient. This is the reason why game scenario, daily living tasks and collaborative/competitive activities are implemented in rehabilitation robots to make the training more interactive and motivating.
The second function of rehabilitation robot is providing support to patients or elders with gait impairments in daily life situations. Prof. Riener showed one of the products developed in his lab called MyoSwiss, a soft exoskeleton that helps people with muscle weakness regain their mobility and independence. The exosuit is already commercially available and the cost is affordable also for home use.
However, for assistive devices, there are still some technical challenges in terms of difficulties in the control of the device and energy supply. In order to promote the development of these technologies, Prof. Riener initiated Cybathlon in 2013, a new kind of Olympics-style championship, where people with physical disabilities compete against each other at tasks of daily life, with the aid of robotic technologies. The first two international competition took place in Zurich in 2016 and 2020. Since then, the Cybathlon platform has been continuously developing and the next one will take place in 2024.
Our fourth speaker Professor Le Xie, Vice Director of Rehabilitation Engineering Institute of Shanghai Jiao Tong University introduced to us the application of virtual reality technology in rehabilitation. A large number of studies show that patients can learn motor skills in a virtual environment, where repeated practice, performance feedback and motivation techniques are ensured by VR technologies. Prof. Xie showed us several VR training systems developed by his lab. The first example was a VR training system for robot-assisted upper limb rehabilitation. The assistant robot with multi-joints was designed based on the seven degrees of freedom of human upper limb. During the 3D modelling phase, 3Ds Max was used to increase the immersive experience.
Another example was hand rehabilitation and assessment system with virtual games such as getting the balloon, playing the piano, moving the ball and picking the fruit. The system trains effectively the hand flexion and extension of the patients and collects real-time data to monitor the rehabilitation progress.
In the Q&A session, topics such as technical/commercial/ethical challenges, connection between rehabilitation robotics and video gaming industry, available robotic device to prevent frailty and possible use of robots in nursing home were discussed.
Finally, a great appreciation to our speakers Prof. Pierre Dillenbourg, Prof. Guang-Zhong Yang, Prof. Robert Riener, and Prof. Le Xie, for their availability and great insights. We also would like to thank the audience who joined our third nexFrontier webinar and participated in the dynamic discussions. Looking forward to meeting you at our next events!