A stroke in Slovenia affects as many as 10 people every day, or 4 thousand people a year. The frequency of stroke increases with the aging of the population, and with it the need for rehabilitation, which is also increasing due to other injuries and diseases.
In rehabilitation, the use of advanced technologies and robots or technologies that work according to robotic principles is becoming increasingly popular. Lokomat, a device for robotic walking training, was the first robot used at the Soča University Rehabilitation Institute to rehabilitate patients who cannot stand or walk independently due to injuries or diseases of the nervous system. Before using the Lokomat, three therapists had to participate in the rehabilitation of walking.
“The advantage of Lokomat is that the exercise can be performed by a single physiotherapist, which means that the exercise can be longer and that the load on the lower limbs, i.e. on the treadmill, is greater and that we can practice walking at a higher speed. So we only increase the intensity of the exercise and its length, which means that the exercise is more effective,” lists the benefits Janez Špoljarchief physiotherapist at URI Soča.
Robotic rehabilitation very effective in the early stage
Human walking is a combination of three activities, explains Prof. dr. Zlatko Matjačić with URI Soča,”cyclic leg activity, weight transfer and dynamic balance maintenance.” And he adds that experts agree that robot-assisted rehabilitation is most effective in the early stages of rehabilitation.”Rehabilitation robots now in clinical practice focus on this first aspect of cyclic leg movement. 20 years of research in this field has somehow brought a consensus that rehabilitation is effective in this early phase and in the most difficult patients, but is not effective in the later phases, due to the fact that these robots limit the movement too much and do not allow the exercise of the other two components of walking.“
That is why the research and development department of the Soča University Rehabilitation Institute is already developing new walking rehabilitation robots that will help patients in the later stages of rehabilitation, when they can do more and more activities on their own.
Hand rehabilitation is one of the most demanding rehabilitations
“The hand is a complex system that enables dexterous and precise movements. It consists of a large number of joints that are moved by a complex system of muscles under the control of a large module in the brain that receives information from many senses. With today’s robotic technology, we cannot achieve the complexity of the hand in any of these aspects, making comprehensive rehabilitation impossible,” explains Prof. Dr. Matjaž Mihelj from the Faculty of Electrical Engineering UL. Therefore, when developing rehabilitation robots for the hand, or devices that work according to robotic principles, they focus on only one aspect of rehabilitation.
Mihelj and the young researcher Ana Mandeljc from the Faculty of Electrical Engineering UL have developed two devices that can be used, for example, for rehabilitation after a stroke. As Ana Mandeljc tells us, she wanted to develop a device that would make rehabilitation after a stroke more accessible and could be used in clinics or even at home: “We focused on the design of a device to rehabilitate wrist and finger movement, more specifically wrist flexion and palm opening and closing.“
While her robot is still in the development phase, the Bimeo device, which is not a robot, but was developed by Mihelj in accordance with robotic principles, is already being used. So far, it has been used by around 12,000 patients in 200 clinics around the world. As our interlocutor explains, some patients are at least partially able to perform movements on their own. “For example, stroke patients usually have preserved motor functions of half of the body and can use these to aid in the rehabilitation of the affected limbs. The Bimeo device takes advantage of this, so it has no active parts, but allows the patient’s responses to be measured, including the force the unaffected limb adds to the affected limb to perform a task.“
In the laboratory of the Research and Development Service of URI Soča, they are also developing two robotic devices for the rehabilitation of the palm and fingers and for the rehabilitation of the hand. Researchers have developed a virtual environment in which the user must solve various tasks. “In the virtual world, you can control the environment, i.e. control the feedback we give to the patient, such as the shape, limitations, where the object can escape, what color the object is, we can more easily determine the level of difficulty. In addition, we can measure the hand movement of the fingers and evaluate these things. All this is theoretically possible in a real environment, but it requires a lot of adjustment,” explains the advantages of the virtual environment, Prof. Dr. Imre Cikalja.
A rehabilitation robot is a sophisticated device, but only a device
Prof. dr. Zlatko Matjačić emphasizes that rehabilitation with the help of rehabilitation robots can be at most as effective as rehabilitation with therapists. “Although the rehabilitation robot is a sophisticated device, it is only a technological aid in the hands of a therapist who has all the expert knowledge to use this rehabilitation robot.” And he adds that in rehabilitation it is usually the patient’s motivation that has a decisive influence on the success of the rehabilitation.”And here, it doesn’t even matter whether the rehabilitation is carried out with a rehabilitation robot. If the patient is somehow not motivated and does not cooperate, the outcome of the rehabilitation will be correspondingly poor.”
A suit that reduces muscle stiffness with electrostimulation
In Sweden, however, they have developed a special suit that, with mild electrostimulation, can help some people with nervous system damage and related symptoms, such as muscle spasms. There are 58 electrodes in the suit, which with electrostimulation reduce muscle stiffness and activate weak muscles, which brings users a less painful and more active life. The suit was designed for people with cerebral palsy and multiple sclerosis, as well as those who have experienced a stroke or brain injury.