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Dr. Alex Mihailidis

Using robots to help with stroke recovery

There are two important factors in helping to regain use of a weakened arm after stroke: safely using the arm as much as possible and repeating prescribed exercises as many times as possible.

Easier said than done.

Most people receive limited rehabilitation therapy (one or two hours day) and only for a period of weeks after their stroke.

Enter the table-top robot, a new way to deliver therapy developed by Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR) researchers at Toronto Rehabilitation Institute (TRI). The robot was developed in collaboration with a Toronto-area robotics firm called Quanser.

The project, led by Dr. Alex Mihailidis, a biomedical engineer and University of Toronto professor, first began six years ago when engineers at TRI consulted more 200 therapists to find out what kind of robot could be designed to help improve arm strength and range-of-motion in people recovering from stroke.

Based on the advice received, the engineers got to work.

What they came up with was a robot that resembles a small suitcase with a hinged mechanical arm protruding from one side. Sitting on top of the suitcase is a computer monitor that links the robot, the therapist, the patient and potentially a whole community of people recovering from stroke.

At the present time, the table-top robot is being tested at a clinic for inpatients at TRI, a concept that is unique in the world.

Patients will be using the robot three days a week for an hour a day. The clinic is open for drop-ins who want additional therapy. “We want to see if patients go there on their own,” Dr. Mihailidis says.

Through the robot, therapists can see how well the patient is doing, his or her current range-of-motion, how quickly, how much error, and how smoothly motions are being completed. This is all tracked over time in order to measure improvement.
At the same time, researchers are doing an economic analysis of the clinic concept versus traditional care.

“With the robot, we are no longer relying on the one or two hours a day a therapist may have to provide therapy to a client,” says Dr. Mihailidis, as he demonstrates the robot in the TRI clinic. “People can come down here and sit down and use this for as long as they want. It has them do the same task over and over again in the exact same repeatable way, which is important for therapy but difficult for a therapist to do because it is so labour intensive.”

The robot uses games and interactive technologies to guide the patient through a series of exercises that involve pushing and pulling the hinged arm back and forth and side to side along a desk. The robot can modify exercises, increase or decrease tension on the arm or add assistive forces to help the patient complete an exercise.

The next step is to develop interactive games that allow stroke patients to compete with others. “You can imagine many of these robots through the community in different homes and patients are competing against different patients at similar levels of recovery,” Dr. Mihailidis says.

The TRI team is in discussion with Quanser about the next steps to manufacture and sell the robots, which are considerably more affordable than anything else on the market. Robots with similar functions sell from $70,000 to more than $150,000, while the TRI group is expecting its robot to sell in the $10,000 to $15,000 range.

“This will be far more accessible to hospitals and clinics,” Dr. Mihailidis says.

The next phase of the research, funded through a Heart and Stroke Foundation and CPSR national telerehabilitation initiative, involves testing the robot for home use, allowing two-way communication with a therapist at TRI and continuous feedback to the patient. Three patients will be recruited for the initial home-based testing.