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Robert RienerSensory-‐Motor Systems LabIns1tute of Robo1cs and Intelligent Systems, ETH ZurichUniversity Hospital Balgrist, University of Zurich
Design Principles for Intelligent
Rehabilita5on Robots
ShanghAI Lecture Series
15 November 2012, 10:00 AM CET
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For the Therapist• Physically exhaus.ng
• Ergonomically inconvenient
For the Pa1ent• Limited training dura.on
• Gait pa;ern not op.mal
SCI Center, Balgrist
Disadvantage of Manual Training
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Human-‐Robot Gait Rehabilita1on
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Gait Rehabilita1on "Robots"GaitTrainer
Hap.c Walker
G-‐EO
Lopes
Autoambulator
HAL
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ETH Zurich/Balgrist, Hocoma AG
Exoskeletal Robot with 7 Degrees of Freedom
Nef, Riener et al. 2006-‐2011
ARMin III
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Arm Rehabilita1on RobotsMIT Manus Bi-‐Manu-‐Track
Hap.c Master, GENTLE/s
MGA
PERCRO Exoskeleton
Salford PMA
KIST Arm
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Sensory-‐Motor Interac1on
Human Machine
Interac.on
Focus: Exoskeleletons for Clinical RehabilitaKon
Setups: Lokomat, ARMin
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Sensory-‐Motor Characteris1cs
To Be Known about Human Physiology
• Nervous system is plas.c
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
• Par.cipa.on increases plas.city
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Passive vs Ac1ve Training
Limita1ons of Passive Training of Healthy Subjects• Physical guidance hinders motor learning of walking balance Domingo &
Ferris, 2009
• High frequency guiding is detrimental for learning of arm movements (guidance hypothesis) Winstein et al. 1994; Marchal-‐Crespo & Reinkensmeyer 2008
Assist-‐as-‐Needed Training (ANN)• AAN shows higher level of recovery step number, periodicity, and consistency (27 mice) Cai et al. 2006
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Lokomat: Pa1ent-‐Coopera1ve Control
Path Control
• Robot behaves assis.ve, correc.ve or transparent, when needed
• Free .ming for pa.ent
• Support pa.ent, but do not restrict pa.ent
Duschau-‐Wicke, Vallery, Riener 2009, 2010, 2011
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Heart Rate
Posi.oncontrol
Path control
Muscle AcKvity
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
0.22
0.24
Init. loading
Mid stance
Term. stance
Pre swing
Init. swing
Mid Swing
Term. swing
Nor
mal
ized
mus
cle
activ
ity (B
F)
Position controlPath control
Rela1ve increase of h
eart ra
te
11 incomplete SCI subjects
Path Control Increases ParKcipaKon
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
• Par.cipa.on increases plas.city
• Repe..on without repe..on
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Path Control Enhances Variability
Posi.on Control
-20 -10 0 10 20 30 400
10
20
30
40
50
60
70
80
Hip angle [°]
Knee
ang
le [°
]
Path Control
-20 -10 0 10 20 30 400
10
20
30
40
50
60
70
80
Hip angle [°]
Knee
ang
le [°
]
“RepeKKon without RepeKKon”
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
• Par.cipa.on increases plas.city
• Repe..on without repe..on
• Provide large ROM, avoid joint stress
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Main Problem with Exoskeletons
Alignment of RoboKc and Human Joints
Human
Robot
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Main Problem with Exoskeletons
Alignment of RoboKc and Human Joints
Human
Robot
Human
Robot
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Main Problem with Exoskeletons
Alignment of RoboKc and Human Joints
Human
Robot
Human
Robot
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Humerus MoKon
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x
y
GH
SC
AC
φ
Δy = 124 mm
Δx = 28 mm
Body height: 1.7 m
Humerus MoKon
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Ver1cal displacementof main drive
Ver1cal shoulder displacement
ARMin II Shoulder Kinema1cs
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ARMin III: Novel Shoulder Actua1on
Humerus Head
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ARMin III: Novel Shoulder Actua1on
Humerus Head
COR
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ARMin III: Novel Shoulder Actua1on
Fixa1on screw
Axis 1
Axis 2
Axis 3
Axis 4α
Force/torque sensor
2 Laser pointers
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Sensory-‐Motor Characteris1cs
To Be Known about Human Physiology
• Nervous system is plas.c
• Par.cipa.on increases plas.city
• Repe..on without repe..on
• Provide large ROM, avoid joint stress
• Each pa.ent is different
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ARMin III: Adjustments
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Reference trajectory
Actual trajectory
Adapt Field with a IteraKve Learning Controller
Lokomat: AdapKve Force Field
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
• Par.cipa.on increases plas.city
• Repe..on without repe..on
• Provide large ROM, avoid joint stress
• Each pa.ent is different
• Mo.va.on increases plas.city
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Human-‐Robot Coopera1on
Audiovisual & hap.c displays
Task specific controller
S1muli
Force and posi.on recordings
Psychophysiological recordings
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To Be Known about Human Physiology
Sensory-‐Motor Characteris1cs
• Nervous system is plas.c
• Par.cipa.on increases plas.city
• Repe..on without repe..on
• Provide large ROM, avoid joint stress
• Each pa.ent is different
• Mo.va.on increases plas.city
• Train ac.vi.es of daily living
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Task Specific Training
Chronic Stroke PaKent (FMA=26)
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Task Specific Training
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Conclusion and Outlook
Taking into Account Human Physiology• Robots can allow efficient & intensive & individual training
• Robot can cooperate to keep the pa.ent ac.ve
• Robots can mo.vate the pa.ent
Chances• Improve health status and quality of life (pa.ents)
• Reduce workload of clinical staff (therapists, nurses)
To do• Clinical evalua1on studies on pa1ents