At Villa Beretta, a cobot model (collaborative robot) is used, which is able to provide better balance and movement control during rehabilitation
They are called "cobots." The acronym stands for collaborative robots. These are robots designed to work together with humans without risk, without protective barriers or other physical elements of separation. In the field of rehabilitation, the use of various robotic systems has increased over the past decade - so much so that in 2022 the Higher Institute of Health felt the need to present a joint document on employment criteria and recommendations - particularly in functional recovery for neurological and orthopedic pathologies that affect movement. and balance.
At the Villa Beretta Rehabilitation Center at Valduce Hospital in Costa Masnaga (Lecco), a new generation self-balancing and multidirectional exoskeleton model has been put into operation, allowing intensive, early and specific training of walking for neurorehabilitation therapy.
"Nothing miraculous," emphasizes Franco Molteni, clinical director of the rehabilitation center. It is a timely, personalized, specific, selective use of technology with the ability to monitor patient outcomes and optimize its use. It's not the solution for everything, and of course it's not the complete solution, but it's a significant therapeutic improvement over anything we've had available to us before."
The differences from the exoskeletons already in use
How is it different from other exoskeletons? "The patient is able to walk with free arms, so in addition to walking, they are able to do more tasks to better coordinate their arms and trunk. The fact that the patient is not leaning on anything completely changes the control of the trunk. The fact that he is basically walking without being held by a physical therapist gives a completely different intentionality to the movement than those who know he is walking with the help of a physical therapist instead. Thus, the sensation of the mode of action also changes, and this affects, for example, the prefrontal control systems and, therefore, the memory components of the movement that is then performed," responds Molteni.
In what cases can it be used?
What kind of patients could benefit? "First and foremost, people with spinal cord injuries, especially if they have incomplete lesions, to stimulate the plasticity of the system, "explains the expert, equally, to stimulate the plasticity of the system, people with brain injuries or with neurodegenerative diseases such as multiple sclerosis rather than Parkinson's and the stages of Parkinson's disease in which there are significant changes in movement control. So from the post-acute phase of all these pathologies to the phase after some time when there is still potential for recovery ".
What can a patient expect during rehabilitation with the Cobot? "In the case of a complete spinal cord injury, an exercise with this type of collaborative technological object may serve to improve trunk control and balance control conditions, which are then transferred in the sitting position, in the transitions from the wheelchair to the bed or wherever you like. In patients with an incomplete lesion, direct the plasticity of the systems toward the best possible control and avoid phenomena of maladaptive plasticity, that is, negative plasticity," Molteni adds.
How many patients do you plan to test it on? "We have 100 dedicated beds and the robotic system works eight hours a day. We will start with a regular application in daily clinical practice and, on the other hand, a series of clinical trials will start to verify the electroencephalographic modifications, the methods and differences in the control of muscle synergies of the lower limbs, and we will also see biological tests on the intestinal microbiota and not on the muscle or even on the bone structure of the patient - emphasizes the clinical director of Villa Beretta -. As for the clinical trials, we already have them set up, but first we need to submit them to the ethics committees, in particular we will work a lot on how the connectivity of the brain changes with different gait modes and different adaptations, as well as on the control of individual muscles that all together determine walking with this system."
How does it compare to another line of research on implantable stimulators for the rehabilitation of patients with spinal cord injuries? "In rehabilitation medicine, it is absolutely necessary to align multiple treatment modalities," Molteni says. Implantable stimulators are a tremendous technological and biological advance, but the outcome of stimulation needs to be refined and consolidated, for example, using a stimulator and a robot like this one. So, it is a perfect synergy to restructure systems that require more actions due to their complexity. The implanted stimulator is not like the pacemaker: it triggers biological mechanisms that then need to be consolidated."
From a movement perspective, however, the cobot denounces the "rigid" nature of the exoskeleton. The steps the patient takes seem very mechanical: Why? "Of course, we need to work on refining the methods to control the interaction. We, who have been using it for a short time, immediately found that the fluidity of the movement can be completely changed within a few sessions, working on the coordination ability of the patient and that of the software to improve the control over the execution speed of the gesture , the coordination between the different motors that make up the cobot. What is important about this model is that it has a motor for the ankle that is coordinated with the motor that controls the trunk, and this is where the use of the software comes in well, otherwise it becomes in some ways a Parkinson's-like pathway."
"Miracle effects? Zero. Having more than twenty years of experience in the use of technologies, we know very well that sometimes we expect a miracle, because we also face incurable diseases.
Here we are discussing a timely, personalized, specific, selective use of technology with the ability to monitor patient outcomes and optimize its use. So it's a great therapeutic advance. It's not the solution to everything, and of course it's not the complete solution, but it's a significant therapeutic improvement over anything we've had available to us before. It's no wonder, because we also set the world record for walking with ReWalk with a patient who managed to walk 10 kilometers and then set the world record for walking 12 kilometers with ExoBionics, but that's proof that you can make important achievements. From there to complete bug fixes, this is very different. But from here, we're on the right track to move forward to solve currently intractable problems. Again, this exoskeleton is not a substitute for a number of other activities that need to be done to restore the path, but it's an important method that's different from anything we've had before, and with very significant development potential."
