CB - Center for Biomechatronics, ECIJG Robot for Coaching during Gait Training with Lokomat: Preliminary Experiment with a Multiple Sclerosis Patient Nathalia Céspedes Gómez, Jonathan Casas, Betsy Jaramillo, Catalina Gómez, Marcela Múnera, Carlos Cifuentes. Email: nathalia.cespedes@mail.escuelaing.edu.co Center for Biomechatronics, Colombian School of Engineering Julio Garavito Rehabilitation Center Mobility Sabana University Clinic CB - Center for Biomechatronics at ECIJG The 13th Annual ACM/IEEE International Conference on Human Robot Interaction Chicago, IL, USA from March 5 – 8, 2018. 1
CB - Center for Biomechatronics, ECIJG Physical Rehabilitation 1 • “ Around 15 15% of the world population has some disability ” (WHO) 1 • Causes: neurological diseases such as stroke and spinal cord injuries (WHO). • Physical Rehabilitation (PR PR) is a continuos process that seeks to imp improve rove the the qu quality lity of of life fe and self lf-relianc eliance of patients. 2 • PR is focused on : physio iologica gical aspects and cognitiv nitive aspects 2 • PR use several methods 3 1 “OMS, Atención médica y rehabilitación”, WHO, 2016 2 W. H. Organization, “full - text,” vol. 4, Rehabil, 2011. O’Sullivan .S et al, [n.d ], “ Physical Rehabilitation ”, 1505 pages 3 The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 1 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Physical Rehabilitation with Lokomat • Lokomat is the gold standar device in the robot-assited therapy. • Enables effective and intensive gait training and ensures the optimal exploitation of neuroplasticity. 4 5 Increase the muscular tone 5 Balance improvement Increase motor control and 6 muscular strength Superior to manual therapy 7 . Lokomat hocoma, “Relearning to walk from the beginning”, web, https://www.hocoma.com/solutions/lokomat/ 4 B. Husemann et al, “Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study,” Stroke , vol. 38, no. 2, 5 pp. 349 – 354, Feb. 2007. G. Colombo, M. Joerg, R. Schreier, and V. Dietz, “Treadmill training of paraplegic patients using a robotic orthosis. ,” J. Rehabil. Res. Dev. , vol. 37, no. 6, pp. 693 – 700. 6 Schwartz I et al, The Effectiveness of Locomotor Therapy Using Robotic-Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial. PM&R 2009, 1: 516-523. / 7 The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 2 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Limitations during Phyisical Rehabilitation Lack of adherence of the patients to the programs . 8 2 8 Economical, social Factors. Anxiety, depression. 8 Low level of physical activity or 8 aerobic capacity, fatigue 2 W. H. Organization, “full - text,” vol. 4, Rehabil, 2011. 8 K. Jack, S. M. McLean, J. K. Moffett, and E. Gardiner, “Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review,” Man. Ther. , vol. 15, no. 3, pp. 220 – 228, 2010. The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 3 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Limitations during Phyisical Rehabilitation with Lokomat • Multiple tasks performed by 9 the therapists during a session. Examples: Simultaneous measurments of gait patterns: ankle kinematics and spinal posture 9 Heather E. Douglas, Magdalena Z. Raban, Scott R. Walter, and Johanna I. Westbrook. 2015. Improving our undersatanding of multi-tasking in health care: Drawing together the cognitive pychology and healthcare literature. Alpplied Ergonomics 59 (2017), 45-55. The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 4 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Social Assitive Robotics In this context, Socially Assitive Robotics (SAR) could be use as a potential tool to improve physical rehabilitation with Lokomat and to cooperate with thrapists to control patient’s performance. • Patien’s positive response in achieving different goals. 10 • Improvement of the movement’s technical tasks during upper limb excersises 11 12 • Decrease the level of stress • Usefull tool to engage the patients to excersise. 13 10 Maja J Matáric et al. Socially assistive robotics for post-stroke rehabilitation. Journal of NeuroEngineering and Rehabilitation 4, (2017),5. Hee-Tae Jung et al. Upper limb ecersises for post stroke patients through the direct engagement of an embodied agent. Proceedings of the 6 th international conference- HRI. (2011).157 11 12 Saito, T., T. Shibata, K. Wada, and K. Tanie, Relationship between interaction with the mental commit robot and change of stress reaction of the elderly. Computational Intelligence in Robotics and Automation, 2003. Proceedings. 2003 IEEE International Symposium on, 2003. 1. 13 Juan Fasola and Maja J Matáric. Using socially assistive human-robot interaction to motivate physical exercise for older adults. Proc IEEE 100, 8, (2012). The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 5 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Human – Robot Interface Development • Structure based on: • Physical parameters : Heart rate 11 12 Cervical and thoracic posture. 13 • Cognitive parameters: Motivational feedback, fatigue perception (Borg Scale). 14 11 Freedson. S and Miller .K, Objective Monitoring of Physical Activity Using MotionSensors and Heart Rate , (2015). 12 Oulette. M et al , High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors, (2004) 13 Lunenburguer,Clinical assessment performed during robotic rehabilitation by the gait training with Lokomat , (2005). 14 Borg, G. (1998). Borg's perceived exertion and pain scales. Champaign, IL, US The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 6 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Human-Robot interface The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 7 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Robot Behavior Table 1. Robot Behaviors during a therapy Behaviors When? Rutine Cervical Posture Bad Posture “ your head is tilted this way, please correct it” Feedback (10°-15° over 0°) “Straighten your back” Thoracic posture Bad Posture Feedback (10°-15° over 0°) “Therapist, your Heart Rate alert HR >(206.9- (0.67*age)) patient has a elevated heart rate ” “Are you tired” Borg scale alert BS>15 “You are doing great” Motivational Good posture Feedback “ You can do it ” Randomly The 13th Annual ACM/IEEE International Conference on Human Robot Interaction Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Preliminar Study Design • A male patient was randomly chosen (Height : 1.83 m, Weight: 60 Kg, Age : 62 years). • Diagnosis: Multiple Sclerosis • Lokomat features : • Speed: 1.5 m/s • 29.2% of body weight support • Therapy Time : 30 min The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 8 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Results “ your head is tilted this way, “ Congratulations!, You please correct it” “ You can do it !” are doing well” End Start Posture Feedback Motivational Feedback Random motivational Feedback Figure 1. Cervical posture registered by pitch, yaw and roll angles during 30 min of Lokomat session The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 9 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Results “ Straighten your back ” “ Congratulations!, You are doing well” “ You can do it !” End Start Posture Feedback Motivational Feedback Random motivational Feedback Figure 2. Thoracic posture registered by pitch, yaw and roll angles during 30 min of Lokomat session The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 10 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Results “ According to the Borg scale, how tired are you? ” Start Borg Scale Request Cool Down Phase “10” Manual Borg scale register Figure 3. Borg scale and heart rate during Lokomat session The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 11 Chicago, IL, USA from March 5 – 8, 2018.
CB - Center for Biomechatronics, ECIJG Results Figure 4. Main Events during 30 min of Lokomat The 13th Annual ACM/IEEE International Conference on Human Robot Interaction 12 Chicago, IL, USA from March 5 – 8, 2018.
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