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.
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.
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.