New Frontiers for Emerging Technologies: Robots as a Tool to Support Therapy during the Pandemic

The COVID-19 pandemic has irrevocably altered the delivery of healthcare services and caused a shift in patient’s expectations. New areas in Social Assistive Robotics (SAR) have garnered increased attention from investors and care providers alike as a potential tool to support clinical care areas, by promoting physical distancing and reducing contagion rates. Social robotic platforms have been used for gait neurorehabilitation in the past, though the pandemic has dramatically increased the scope and replication opportunities the technology presents. In the context of upper and lower limb rehabilitation the robot’s primary purpose is to monitor the physiological progress of the patient while allowing for social interaction with a remotely-stationed care provider during the sessions. Multiple clinical validation sessions were conducted in rehabilitation centers across the globe. Results showed that the use of SAR positively impacts the patients’ physiological progress by correcting stance and posture while dispensing advice and encouragement and promoting the patient’s feeling of positive reinforcement. Patients have found the SAR platform both helpful and secure. Care providers also acknowledged the important role the robot plays within neurorehabilitation therapy, and further praised SAR as a vital tool promoting physical distancing without sacrificing vital patient support throughout the pandemic. Industry forecasters suggest increased usage and wider applications of this technology both during and in the aftermath of the pandemic.
​
Healthcare services were forced to establish strategies promoting physical distancing while continuously providing adequate support to their patients. As physical distancing and isolation procedures were adopted, new studies corroborated positive outcomes where these measures were adopted, including a decrease transmission rates, reduction in peak incidence, and a marked drop in intrahospital interactions. Widespread concerns emerged around possible alternatives to classical rehabilitation practice that would enable the provision of neurorehabilitation services during the COVID-19 pandemic, as patients with disabilities and chronic / progressive conditions require constant monitoring and care. Social Assistive Robotics (SAR) saw increased attention in terms of funding and research as a newfound momentum pushed the exploration of new technologies to support the general population’s health during the pandemic.

The current global pandemic validates SAR applications, as they play a critical role in supporting the rehabilitation’s continuity. SAR and Assistive Robotics (AR), beyond providing physical assistance to patients, also offer users cognitive support and social interaction. These categories of robots need to perform tasks with a high degree autonomy in order to achieve sufficient levels of interaction. SAR and AR based applications are developed and enhanced in multiple clinics and educational facilities. Positive effects on patient’s motivation and higher adherence to medical treatments have been shown to increase with AR enabled reliability, support and interaction. In the context of COVID-19, medical research has been focused on two main applications of SAR; patient monitoring and connecting care providers to patients using teleoperations. SAR offered a method that sustains social distancing protocols while serving as a remote health monitoring tool in high-risk areas, aiding both patients and healthcare staff. SAR has been further applied in hospital environments to enhance patient’s mental state and well-being.

A social robotic platform for neurorehabilitation using Lokomat was developed during the COVID-19 pandemic. Lokomat is a device that combines bodyweight support systems with a robotic orthosis in order to assist the gait of a patient by using repetitive specific tasks. This platform allows the measurement of different parameters: the patients’ strength, mechanical arduousness and range of motion. These parameters provide feedback to the physiotherapist so that changes to the therapy can be made in accordance with the goals and progress of each individual patient. Yet, some parameters deemed essential to the rehabilitation process including heart rate, posture, and patient’s fatigue level may not be reliably measured and recorded by the Lokomat, and clinicians usually monitor these parameters directly using external equipment, visual cues and verbal communication with the patient. Monitoring the patient’s heart rate permits the observation of a patient’s physical progress in terms of cardiovascular functionality, while correcting the spinal posture ensures the correct application of a given therapy while decreasing muscle fatigue. In this respect SAR constitutes a valuable complementary tool, automatizing these parameters, providing feedback and a means to interact with patients during therapy in times when physical distancing has become the new norm.

Different studies show the capabilities of SAR in post-stroke patients to support rehabilitation procedures following the cognitive approach protocols. Social care robotic platforms aiding post-stroke patients through contactless assistance have been designed roughly ten years ago to assist remote care provision. Pilot studies before the pandemic were designed to test the technology – mobile robots supported various therapies via key measurements, but they also provided encouragement and reminders. The researchers found that welfare robots were well-received by stroke survivors and positively impacted their willingness to undergo rehabilitation. Currently, a SAR device designed for upper limb rehabilitation therapy has been used in some European clinics.

These ‘social robots’ have enhanced interface features, and assist care providers by employing physiological parameters for monitoring and feedback. Some researchers have engaged a humanoid robot to assist cerebral palsy patients during motor training activities. This particular robot was designed to support young children. While indications that patients enjoy and value their interactions with the robot abound, the technology was slow to expand to other areas of rehabilitation before the advent of the global pandemic. In a post-covid world, rehabilitation scenarios in which SAR devices are essential have become quasi-ubiquitous. Beyond ensuring the continuous treatment of physically distanced patients, these devices increase patient motivation and willingness to complete the procedures. Similarly, in pediatric rehabilitation, researchers have highlighted the beneficial effects of using robots to actively engage young patients while increasing their commitment to perform the exercises. In 2020 a humanoid robot was created to guide patients (via imitation) through complex postures and exercises. Depending on the patients’ performance, the robot would either congratulate or correct the users.

The SAR and AR technological improvements since 2020 will pave the way to further progress in alternative rehabilitation approaches and even spill-over into new med-tech areas where they would be instrumental in promoting patient health.