The History of Medical Robots!

The field of Physical Rehabilitation, like all medical fields, is constantly evolving. Maybe the approach and philosophy of gait training hasn’t changed very much in the last several decades, but the equipment used for gait training certainly has. From body-weight support harnesses and hands on facilitation techniques, to functional electrical stimulation and robotic exoskeletons, advancing technologies has provided more options for therapists and patients alike when considering rehabilitation needs. Understanding the history of technology and the evolution the products you wish to utilize in your or your patient’s recovery, is an important and necessary aspect of receiving/providing the best care available.

Today’s neurochangers post is a special guest submission from Philip J Reed. Philip discusses the history of medical robots, current robotic applications, and a look into the future of robotics. We hope you find his post informative and insightful, and please feel free to leave questions/comments for Philip in the comments section below. – Matt Sanchez, neurochangers

 

The History of Medical Robots

–Philip J Reed, on behalf of The George Washington University Hospital

The term medical robots can be somewhat misleading, conjuring images of independent machines performing preprogrammed tasks without supervision. Such applications may work on an industrial level, but when dealing with the human body, human skill is very much involved and enhanced. Medical robots have only been in use for a few decades, but their presence is increasing dramatically.


History and Milestones

The origins of robotic surgery began with laparoscopic procedures. Watching a two-dimensional video monitor while manipulating somewhat awkward instruments reduced accurate visualization of the surgical field and limited the normal range of motion in surgeons’ hands; both of these significantly lessened laparoscopic advantages. Desire to overcome these limitations led to the development of surgical robots.

The first use of surgical robots occurred in 1985 with the PUMA 560, which allowed precise control in neurosurgical biopsies. In 1988, doctors used the same equipment in prostate surgery; however, they soon had the PROBOT, which was designed specifically for prostate work. In 1992, the ROBODOC assisted surgeons in total hip replacements; this surgical robot had the distinction of being the first to receive approval from the Food and Drug Administration (FDA).

The late 1980s and the 1990s saw a great deal of work in the area of telesurgery, or telepresence surgery. These involved the ability to remotely perform procedures, such as with wounded soldiers on a battlefield. The research led to development of the da Vinci robot, a system that allows a surgeon to work across the room from a patient while directing robotic arms via controls and a video display. It received FDA approval in 2000 as the first comprehensive robotic system for laparoscopic surgery.

Along with surgical developments, there has been tremendous progress in the area of prosthetic limbs. Prosthetic knees with microprocessors began reaching the market in 1993. In 1998, the Adaptive Prosthesis combined microprocessors with hydraulic and pneumatic controls to provide more natural walking ability and greater responsiveness to changes in walking speed. The C-Leg debuted in 1997 and furthered control of knee flexing. It has developed into a sophisticated prosthesis that adapts to each individual user and allows such activities as rollerblading and biking.

Current Medical Robotics Applications

The range of applications for medical robots has flourished in recent years. Hospitals report hundreds and even thousands of procedures performed with the da Vinci robot, which now has the delicate ability to precisely peel a grape. It’s used in all manner of surgeries, from heart-valve repair to tumor removal, and across various surgical disciplines.

The ROBODOC now combines with ORTHODOC to preplan surgical procedures and carry them out with exacting detail. ROBODOC also assists with knee replacements.

Robotic prosthetics now include sensors that attach to muscles and nerves, allowing patients to enjoy a sense of touch and to control movements with thought. Prosthetic hands allow fine motor skills, such as writing, typing or playing piano.

Robots might have “feelings” after all!

 
With the help of a robotic exoskeleton, stroke victims can regain lost arm movement quicker than with traditional physical therapy. Able to mimic 95 percent of fully functional human arms, patients strap on the robotic arms and perform a series of exercises. Sensors detect muscle strength, range of motion and also brain activity, informing therapists of progress. The machine also helps retrain the brain, enabling healthy areas to compensate for stroke-damaged ones. Robotic systems also help patients relearn walking and other motor skills.

Robotic surgery has accomplished its goal of removing the limitations of laparoscopic surgery. It has returned three-dimensional visualization to internal surgical spaces and even slightly increased the normal range of motion. Very fine movements are possible, as evidenced by the grape-peeling demonstration, and the ability to perform 360-degree rotations with delicate instruments further increases a surgeon’s capabilities. The other laparoscopic advantages of reduced blood loss, less pain, lowered risk of infection and quicker recovery time are all enhanced with the precision of robotic instruments.

Disaster victims and emergency responders also benefit from medical robots. Small robots can enter collapsed buildings or other inaccessible areas to search for survivors. With camera equipment, medical teams may be able to assess a person’s condition, and audio capabilities permit communication. Current technology allows these small machines to sense breath, to read thermal signatures to assess blood flow in extremities, and even to determine pulse and blood-oxygen readings if survivors are positively positioned. They can prod a victim to attempt a physical response, and they also have the ability to deliver oxygen and water through attached tubing. These combined capabilities can help keep someone alive and also allow medical personnel to have additional treatment ready after extraction.

The Future of Medical Robots

Developing technologies take robotics even further. Future robotic surgery may become even more remote, performed from a separate room or even from across the country. There may be advancements in the touch component of surgery, which is missing somewhat in current robotic procedures; combining the precision of mechanical enhancement with the sensation of touch could be an ideal surgical scenario.

Researchers in Singapore are developing a tiny crab-like robot that can crawl through the mouth and into the stomach, remove cancerous growths and also stop internal bleeding. Even smaller technology may be possible in nano-robots, which could potentially deliver chemotherapy to specific cells, return detailed diagnostic information, or perform intricate eye or brain surgery that is currently risky or impossible. What was recently only imagined may be well within reach with medical robots.

THE FOUR PRINCIPLES OF HEALTH

HEALTH – “soundness of body or mind; freedom from disease or ailment”.  Although you may easily find this, or other similarly broad and general definitions of health, you will be challenged to find an easy-to-follow guide of how to actually achieve an optimum level of health.  The Aim2Walk protocol emphasizes health as an integral cog in the wheel of integrated neurological rehab.  Recently, we were fortunate to add a very talented and experienced Certified Nutritional  Practitioner – Sandra Florio – to our team of therapists at Aim2Walk.  Sandra is also a Registered Orthomolecular Health Practitioner, a special designation from the International Organization of Nutritional Consultants, which means she ‘specializes in maintaining or restoring biochemistry and physiology in the body for optimum health and well-being’.  That sounds like the perfect specialty to explain how to maintain a satisfactory level of health, so please enjoy Sandra’s Neurochangers debut…

There are 4 basic principles to be followed in bringing about and maintaining a satisfactory level of health. They involve attending to: nerves/innervation, blood and lymph integrity, circulation and rest.

1. Nerves/Innervation

The nerves are the central communication system of the body, receiving input stimuli and carrying instructions constantly to the glands, organs, muscles and brain. Optimum innervation is the number one priority in the physical body. The nervous system is the first to develop in the embryo and the last to be affected in case of starvation. A free and uninterrupted flow of nerve force is necessary to allow healing to take place.

Without sufficient innervation to tissues we do not have the power for proper assimilation of food or elimination of toxins and wastes. Without proper assimilation it is difficult to stimulate an increase in red blood cell count and satisfactory circulation of the blood and lymph. When neural integrity is disrupted, it may be difficult to enjoy restful sleep or relaxation. Without proper innervation muscles become flabby, and exercise is difficult and tiring. The nervous system must be restored to effective functioning before the full benefits of the other three principles can be realized. With adequate innervation every physical system and organ functions more effectively.

2. Blood and Lymph

The life of the body is in its blood and lymph. Lymph differs from blood in that it is a colourless fluid formed in tissue spaces throughout the body, much like blood plasma, but containing no red blood cells.  It flows through the lymphatic channels and eventually empties into major ducts that lead into large veins near the heart. The blood carries biochemical nutrients, including oxygen, to the cells of the body and removes toxins, bacteria, carbon dioxide, and wastes.  In a similar fashion the lymph absorbs and carries nutrients into the blood stream. Lymph does not circulate as blood does but travels one way through a system of small vessels that pass through lymph nodes which filter out bacteria and other foreign material, preventing their entrance into the blood stream while letting nutrients pass through. Good blood and lymph supply are essential for health. In the bloodstream white blood cells act as defenders against any harmful bacteria, toxins, or other substances by consuming them and carrying them into the excretory channels.

Arterial blood is rich in nutrients and oxygen while venous or ‘sludge’ blood is dark in colour and loaded with cell waste products.  In order to recover or sustain health, it is necessary that we provide the right foods and liquids to build up the blood and lymph systems.  In the case of illness or injury, we want to build up the red blood cell count for quicker tissue repair and removal of toxins and wastes.

3. Circulation of Blood

Blood makes up one fourth of the entire body weight, and to perform its vital job of carrying food to the various tissues and of removing wastes, it must circulate efficiently. Proper blood circulation is crucial to the healing process. Often it is taken for granted that the heart is the “pump” that drives the blood through the network of arteries, veins, and capillaries that serve the body. However, the legs are also pumps. They are the pistons that drive blood through the body. The activity of walking or any exercise involving the legs, particularly, aids the circulation of blood through the venous system. Normally, blood moves through the main arteries at a rate of one foot per second and makes its round-trip through the circulatory system in about 20 seconds. For the average person living at sea level, there are from 4.5 to 5 million red blood cells in each cubic millimeter of blood. These important and life giving cells, travel through the circulatory system 180 times per hour, and any physical dysfunction that reduces this rate of travel (or increases it significantly) impairs the process of cellular function in all body tissues. Without adequate circulation, we cannot get the biochemical elements needed for tissue repair into the various parts of the body fast enough, and we cannot carry away toxins and waste products as rapidly as we should.

4. Rest

This is often the most neglected of the four principles. Fatigue, overwork and overexertion play a prominent role in the breakdown of physical tissue. All sick people are tired.  There are emotional and psychological sources of fatigue as well which are equally destructive as the physical. It is crucial that we get enough rest, relaxation and recreation to restore our bodies to a high level of functioning.  During sleep, metabolism slows, body temperature drops and half as much air is taken in by the lungs. Muscles relax, perspiration increases, blood pressure drops and urine output decreases. It is also interesting to note that in a sleep state, our bodies are not fighting gravity as they are during daytime activity when the skeletal structure is supporting the softer tissues and organs in an upright position.  Alterations in the metabolism of the body during rest favour the restoration of damaged tissue and the efficient removal of toxins. During rest, the nervous system effectively organizes and harmonizes the functioning of the various organs, glands, and tissues to combat and reverse a degenerative condition.  The blood circulation to the affected body part is not impeded by demands made upon it by other competing physical activities, as it is during an ordinary work period. Complete rest is best during times of illness or injury.

Each of the four principles is interdependent upon the others. When we improve one, the functioning of the other three is enhanced. This idea can extend to the whole person – when body, mind, and spirit are in harmony, good health is a natural consequence. This notion is supported by the wholistic approach to healing whereby the whole person is treated in order to restore balance and health.

Sandra Florio, B.Kin(Hons), CNP(Hons), RNCP, ROHP
Sandra holds a Bachelors degree with Specialized Honours in Kinesiology and Health Sciences from York University where she was a valuable member of the varsity volleyball team.  She then graduated from the Institute of Holistic Nutrition on the Dean’s list with First Class Honours becoming a Certified Nutritional and Orthomolecular Health Practitioner.

She has since completed certification in Clinical Detoxification and Clinical Iridology, incorporating this innovative diagnostic analysis into her practice.

Iridology is the science and study of pathological and functional disturbances in the human body as indicated by abnormal markings and color changes within the iris of the eye.

Clinical Iridology focuses on the accurate assessment of an individual’s particular health challenges and predispositions and perfectly complements the focus of natural medicine and orthomolecular holistic nutrition – restoring the strength and vitality of the body’s organs and tissues.

Sandra possesses an overwhelming enthusiasm for all things concerning health and fitness.  She ranks among the nation’s top professional beach volleyball players, has won 3 silver medals at the Ontario provincial championships, and has represented Canada on the FIVB world tour.

Sandra offers nutritional counseling including dietary and supplemental protocols addressing a variety of conditions and concerns as well as specific nutritional regimes for accelerated healing and recovery, and protocols tailored to biochemical and metabolic individuality.

She is a proud member, in good standing, with the Certified Nutritional Practitioners Council of Canada, as well as the International Organization of Nutritional Consultants.  Her services are covered by most extended healthcare policies.