Robotic Mechanotherapy: A New Frontier In Rehabilitation

Introduction

Robotic mechanotherapy, the process of integrating advanced robotic technologies in rehabilitation, has emerged as a transformative approach for patient recovery across a variety of health conditions. This article synthesises recent research on the application of robotic mechanotherapy in stroke rehabilitation, treatment of multiple sclerosis (MS), shoulder joint pathologies, and its role in skeletal muscle regeneration.

Robotic mechanotherapy in stroke rehabilitation

A stroke happens when there is a reduction or blockage in the blood flow to a portion of the brain. Depriving the brain tissue of oxygen and nutrients can lead to brain cells dying within minutes, affecting different bodily functions depending on the brain area impacted. For example, a person may experience difficulty speaking, moving one side of their body, or other challenges depending on the severity of the stroke.

Post-stroke rehabilitation is the process of helping individuals regain as much independence and functionality as possible. It involves various therapies and exercises aimed at relearning skills lost or altered after the stroke. The goal is to help survivors adapt to new limitations and restore their abilities as much as possible. 

The role of robotic mechanotherapy in stroke recovery

Recent research has brought to light the effectiveness of the robotic mechanotherapy system in supporting the rehabilitation of stroke survivors.¹ The device combines robotic leg braces (orthoses) with a treadmill to provide guided, repetitive, and precise movement exercises. This advanced approach allows for the controlled simulation of natural walking patterns, which is crucial in regaining movement skills.

For patients recovering from ischemic strokes, where blood flow to a part of the brain is blocked—the mechanotherapy device has proven especially beneficial. It has shown remarkable results in enhancing core rehabilitation outcomes, such as:

• Improvement in movement skills: The mechanotherapy device facilitates repetitive and controlled motion, which is essential for retraining the brain and muscles to coordinate movements effectively again.
• Enhanced walking symmetry: Stroke often disrupts the balance and symmetry of walking. The mechanotherapy device helps patients regain a more balanced and symmetrical walking pattern.
• Support for the paretic leg: In many stroke survivors, one leg may be weaker or less functional, the so-called paretic leg. The mechanotherapy device supports and strengthens this leg to help recover walking ability.

Integrating technologies like the mechanotherapy device into rehabilitation aligns with modern therapeutic practices, focusing on efficiency and effectiveness in the recovery journey of stroke patients. Such advancements highlight a promising direction in stroke rehabilitation, in which technology helps to focus on the patient’s outcomes. 

Robotic mechanotherapy in multiple sclerosis

Multiple sclerosis (MS) is a long-term neurological condition that primarily affects the brain and spinal cord, which are the key components of the central nervous system. Essentially, the body's immune system mistakenly attacks the protective covering of nerve fibres, known as myelin. This attack disrupts communication between the brain and other body parts. MS symptoms are diverse and can range from general fatigue and difficulty walking to feelings of numbness, muscle weakness, and issues with coordination and balance. The intensity and types of symptoms can vary widely from one person to another and may change over time.

Exoskeletons: a leap forward in MS rehabilitation

Imagine wearing a device that boosts your physical strength and abilities – that's what an exoskeleton is. It's a type of wearable technology, often resembling a suit, designed to support people who have difficulty moving. These exoskeletons have a sturdy framework, and they're typically powered by motors or hydraulic systems, which work to assist or even enhance the wearer's natural movements.² In rehabilitation, they're incredibly valuable for helping people regain movement and functionality in limbs impacted by conditions like stroke or MS.³

A 2021 study sheds light on how the exoskeleton aids people with MS.⁴ Involving 53 participants; this research marked notable progress in rehabilitation through the use of this technology. Here's what they found:

• Boosted walking speed: By using the exoskeleton, patients could walk faster, showcasing improved mobility and a greater level of independence. Increased speed was observed in the Timed 25-foot Walk test, a standard assessment for gauging walking speed.
• Upper limb function insights: Although the study's primary focus wasn't on upper limb function, overall physical improvements were evident. The 9-Hole Peg Test (9-HPT), used to measure hand and arm capabilities, helped gauge these enhancements.
• Cognitive function boosts: The study also reported better cognitive function in participants. Improved cognition is a vital finding since MS can affect brain functions, including memory and problem-solving.

In summary, the exoskeleton has shown promise in enhancing the rehabilitation process for MS patients, particularly in terms of walking speed and cognitive abilities. The integration of such innovative technologies in treatment underscores a growing trend in medical rehabilitation. Research on exoskeleton highlights that holistic therapeutic approaches are needed to address both physical and mental health aspects. 

Robotic mechanotherapy in treating shoulder joint pathologies

The shoulder, a complex and highly mobile joint, is susceptible to various pathologies due to its anatomy and biomechanics. Shoulder joint issues can arise from injuries, chronic diseases, or post-surgical complications, leading to pain, limited movement, and decreased quality of life. Conditions like muscle wasting (muscle atrophy), contractures (stiffening), and osteoporosis can develop, particularly when the joint is immobilised for long periods. Rehabilitation, therefore, becomes crucial to restore function and alleviate these symptoms.

Why joints might need rehabilitation

Joints like the shoulder may require rehabilitation due to several reasons:

• Injuries and operations: these can lead to immobilisation, causing secondary changes such as muscle atrophy (wasting) and joint stiffness.
• Chronic conditions: Diseases affecting the shoulder can lead to progressive limitations, requiring therapeutic interventions.
• Functional disorders: Prolonged inactivity or immobilisation can severely limit the movement of the joints. Restoring their function is possible with rehabilitation, such as mechanotherapy.

The role of robotic mechanotherapy

Robotic mechanotherapy, a novel approach to rehabilitation, involves using robotic devices to assist in the recovery process. It's particularly beneficial for joints like the shoulder, where precise movement and controlled loading are essential for healing.

In a 2023 study, researchers looked at the effectiveness of the robotic mechanotherapy device in treating shoulder joint pathologies.⁶ The study involved 60 patients and demonstrated significant improvements:

• Increased joint movement: Patients experienced an increased range of motion in the shoulder joint.
• Pain reduction: The therapy significantly reduced pain levels, improving the quality of life and daily activities.
• Enhanced blood circulation: The treatment increased a measure for improved blood flow in the shoulder joint area, indicating better circulation and nervous regulation of the muscles.

The 2023 study highlights the potential of robotic mechanotherapy in increasing the functionality of the shoulder joint. The robotic mechanotherapy device, through controlled and precise movements, helps to restore mobility, reduce pain, and improve overall joint health. The introduction of this device in the early stage of the rehabilitation process is recommended for better outcomes, potentially shortening the recovery and enhancing the functional range of motion in the shoulder joint. This advancement in rehabilitation technology offers a promising direction for treating various joint pathologies, emphasising patient-centric and technologically advanced therapies.

Robotic mechanotherapy in skeletal muscle regeneration

Muscle tissue regeneration is the body's natural process of healing and rebuilding muscle after injury or damage. It's vital because it helps restore strength and functionality to the affected muscles, enabling individuals to regain mobility and return to their daily activities. This process involves the repair of muscle fibres and muscle cells regeneration, crucial for maintaining muscle health and function.

Importance of muscle regeneration

• Restoration of function: Effective muscle regeneration is essential for restoring strength and movement, especially after severe injuries.
• Quality of life: Successful muscle healing directly impacts an individual's ability to perform daily activities, enhancing overall quality of life.
• Prevention of chronic conditions: Proper regeneration can prevent long-term issues like muscle weakness or atrophy, which can arise from incomplete healing.

Robotic mechanotherapy's role in muscle repair

Another study explored the innovative use of robotic actuation in skeletal muscle regeneration.⁵ This study provides insights into how controlled mechanical forces can significantly help in repairing severely injured muscle. Here's how:

• Controlled mechanical forces: The study used a robotic device to apply specific compressive forces to the muscle, offering a precise and consistent method for aiding muscle repair.
• Enhanced functional recovery: This approach led to substantial improvements in muscle function. The robotic system helped accelerate the muscle's natural healing process by providing consistent and controlled mechanical stimuli.
• Clearance of neutrophils: A key finding was the role of mechanotherapy in clearing neutrophils – a type of immune cell involved in the first response to an infection. While necessary for initial healing, the prolonged presence of neutrophils can hinder muscle regeneration. The robotic system's controlled forces sped up their clearance, facilitating better muscle repair.

This study highlights the potential of robotic mechanotherapy in enhancing muscle tissue regeneration.⁵ This technology offers a novel, non-invasive way to boost the body's natural healing processes by applying controlled mechanical forces. This approach could revolutionise how we treat muscle injuries, offering faster, more effective recovery and improving the quality of life for those affected by muscle damage.

Summary

Robotic mechanotherapy devices are revolutionising rehabilitation across various medical conditions. In stroke recovery, they enhance movement skills and walking symmetry. They retrain the brain and muscles through controlled, repetitive motions. For Multiple Sclerosis (MS), these devices improve walking speed and cognitive functions.

In treating shoulder joint pathologies, robotic mechanotherapy increases joint mobility and reduces pain. It also improves blood circulation. In skeletal muscle regeneration, these devices speed up muscle healing. They improve muscle function and assist in immune cell clearance. This technology marks a new era in holistic and patient-focused medical care.