An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Rehab Robots

How robotic-assisted therapy is helping patients recover

During the Iraq War, Damon Boxie’s job was to keep the troops supplied. He spent five years there as a transportation foreman for a private contractor. Several colleagues were killed but he managed to avoid serious injury. 

Back in the Houston area on a two-week vacation, Boxie was injured in a motorcycle accident on July 3, 2011. He suffered a spinal cord injury that robbed him of the use of his legs. After his surgery two days later, he was listed as a quadriplegic. 

Following a month at Memorial Hermann-Texas Medical Center, Boxie, a father of two, began the road to recovery at a TIRR Memorial Hermann facility. “I want to get back to where I can walk again,” Boxie says. 

Boxie is one many patients benefiting from robotic-assisted therapy, which complements the work of therapists. When teaching someone how to walk again, therapists often use a device that supports the patient while they manually move the person’s legs on a treadmill. The therapist can adjust the speed of the gait, as well as the amount of weight that is being put on the legs. 

“It feels like a football workout,” Boxie says. “It stretches the hip and core.” 

Thanks in part to the robotic device, Boxie, who lives in Fresno, Texas, has gotten back on his feet with the help of a walker and is well on his way to walking unassisted. 

Boxie’s rehab doctor, Jeffrey Berliner, DO, is an assistant professor of physical medicine and rehabilitation at The University of Texas Health Science Center at Houston (UTHealth) Medical School and clinical chief of spinal cord medicine at TIRR Memorial Hermann. He says the exercises re-educate the muscles. While damaged nerves often cannot be repaired, new nerve connections can be made and old ones reignited. 

“Mr. Boxie has a fantastic attitude and you can see it in his progress,” says Berliner, noting that the robotic device allows doctors to keep exact records of the patient’s progress. 

Robots have been used for decades in the private industry to perform repetitive tasks. But unlike the ones you see in movies like “The Terminator” and “Star Wars,” these machines are typically not human-like. In Boxie’s case, the device looks like metal braces that are secured to his legs and then mechanically activated. The technical term is an exoskeleton or external skeleton.

Robots are now being used to help people regain the use of arms and legs that may have been impaired due to injury or disease. Approximately 250,000 people are living in the United States with a spinal cord injury, Berliner says. Millions of people in the United States have had a stroke, a leading cause of long-term disability. 

“This is an exciting time for rehabilitation,” says Gerard Francisco, MD, chairman of the Department of Physical Medicine and Rehabilitation at UTHealth Medical School and chief medical officer at TIRR Memorial Hermann. “We have so many things now that we can do for our patients.” 

“What we do in rehabilitation is to support and facilitate the recovery, which would occur naturally,” Francisco adds. “Our goal is to bring people back to the community and live productive and satisfactory lives. We like people to get back to work, back to school and to the things they enjoy. The focus is on recovery, restoration and reintegration.” 

In addition to utilizing commercially available robotic devices, Francisco and his colleagues are involved in research designed to provide added value to existing products. For example, the UTHealth Motor Recovery Lab at TIRR Memorial Hermann is evaluating a robotic device developed by Marcia O’Malley, PhD, an associate professor of mechanical engineering and materials science at Rice University, to restore function in wrists and forearms in persons with spinal injuries. 

Called the MAHI Exo II, the device is unique in that it is focused on the end of the arm rather than the shoulder, O’Malley says. It is one of the first research initiatives in determining if robots can help upper-limb recovery in persons with spinal injuries. 

O’Malley defines robots as devices that can sense, think and act. She says rehab robots could become commonplace as the price drops. In the future, she can see a single therapist overseeing a roomful of patients being attended to by robotic devices. She predicts patients taking their robots home and doing their rehab there. She also envisions a time when robots do the walking for people with impaired mobility. 

In addition to performing repetitive tasks, the devices can be designed to make therapy sessions fun for patients, according to Beena Kalathoor, an occupational therapist at TIRR Memorial Hermann. 

For example, people who suffer a stroke often lose the use of the limbs on one side of the body. Kalathoor uses a video game-like device to capture patient interest. With an arm in a mechanized sling, a patient performs such tasks as catching rain drops in a mug before they hit the ground or wiping clean a window. 

“We never had an interactive component in the past. We just asked the patients to do the same task over and over,” she says. 

TIRR Memorial Hermann patients using this upper-extremity device include Kathaleen Rodriguez, who suffered a stroke. “Beena asks me to do things that are easier said than done. But, I can now open a door. I can turn a light switch on and off.” 

There are still more things Rodriguez would like to do. And with the assistance of rehab robots, she hopes one day to be able to style her own hair and hit the road.

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