Giving Patients Hope with Rehabilitation Robotics
SIT Physiotherapy students conduct research on rehabilitation robotics in patients' homes.
One day, stroke survivors and persons with disabilities may be able to experience rehabilitation robotics therapy in the comfort of their own homes.
When A/Prof Wee Seng Kwee is not teaching classes at SIT, he can be found caring for neurological patients at the Clinic for Advanced Rehabilitation Therapeutics (CART) in Tan Tock Seng Hospital, where he is a Senior Principal Physiotherapist. After spending close to three decades at his first job, he remains passionate about clinical work.
He said, “My work at the clinic allows me to use real-life examples to enhance my students’ learning. With my patients' consent, I am able to capture appropriate videos of therapy sessions for my classes at SIT.”
A/Prof Wee in the days he spent as a Visiting Fellow at the University of Southampton, United Kingdom. (Photo: Wee Seng Kwee)
In recent years, A/Prof Wee has spearheaded several research studies on rehabilitation robotics and their impact on the recovery of stroke survivors and persons with disabilities. With the rapid advancement of rehabilitation robotics technology, more companies are producing a wide range of devices to aid rehabilitation therapy.
So just imagine an exoskeleton that a patient can wear on their torso, which is spring-loaded at the shoulder joints to help them lift weakened arms, or a motorised wheelchair that can ‘transform’ seamlessly whenever a patient wants to sit, stand, or walk. These are just two examples of the devices available in the fast-growing field.
A Handy Research Study
In September 2021, A/Prof Wee secured the loan of a portable robot hand from Fourier Intelligence. The HandyRehab™ is a wireless, portable robotic exoskeleton that weighs little more than a canned drink. It is designed to retrain weakened muscles and restore various hand functions and movements in patients with weakness of the hand due to post neurological insults, such as stroke, traumatic brain injury, and spinal cord injury.
A/Prof Wee explained, “Stroke survivors tend to suffer from weak muscle strength and poor coordination. They also tend to have a high muscle tone that makes their hands curl up or cramp, which makes it difficult for many survivors to grasp and hold objects. Performing daily tasks such as putting on a shirt, making a beverage, or using the phone becomes very challenging.”
Year 4 Physiotherapy student, Eric Foo helping a patient use the HandyRehab™ robotic exoskeleton to grip a water bottle and practise drinking from it in the home environment. (Photo: Wee Seng Kwee)
Helping Patients Feel Empowered
Together with a group of Year 4 Physiotherapy students, A/Prof Wee conducted a research study to trial the HandyRehab™ robot. The research team collaborated with Kwong Wai Shiu Hospital and Ang Mo Kio-Thye Hua Kwan Hospital to recruit 10 stroke participants for the study. At the end of the trial, the team generated a list of 50 activities that patients could do using the HandyRehab™ robot. The list would serve as a comprehensive reference guide for clinical practice by physiotherapists and occupational therapists. Some of activities include opening a jar, writing with a pen, drinking a cup of water, using a computer mouse, hanging up the laundry, and more.
The robot works by detecting muscle activity through the robot’s electromyographic (EMG) sensors. When a user makes slight twitches in the muscles, it triggers the robot to open and close the user's hand. The physiotherapist can also manually control the hand wirelessly from a computer tablet. Hence, users without muscle activity can still experience hand movements and perform some daily tasks. Over time, intensive and repetitive task-specific training can help facilitate brain plasticity and promote patients' recovery.
Devices like the HandyRehab™ robotic exoskeleton can bring life-changing benefits to stroke survivors. One of the participants in the study was thrilled that wearing the hand robot enabled her to hold a broom and sweep the floor. It gave her hope that intensive rehabilitation therapy would enable her to perform tasks that she used to do before her stroke.
A/Prof Wee shared, “A loss of independence is devastating to many stroke survivors and often affects their emotional and psychological well-being. Enabling them to perform simple daily tasks helps patients regain their sense of control and confidence; improves their self-esteem and psychosocial well-being; and boosts their cognitive health.”
The experience also had an impact on his students. Aside from learning about the functional aspect of the rehabilitation robots in real life, the students could observe first-hand how technology can transform lives for the better.
Therapy in the Comfort of Home
A/Prof Wee said, “We carried out our research in patients' homes whenever we could, instead of in a clinical setting. This is something we are striving towards. It is more convenient for patients to receive therapy at home; the therapists can make more accurate assessments and recommendations for the patients' therapy and care.”
Unsurprisingly, such cutting-edge rehabilitation technologies are expensive. However, A/Prof Wee is hopeful that a greater demand for rehabilitation technologies will make it more affordable in the future, so more patients can benefit from using the devices within their own homes.
While technology can do wonders, no device can replace the expertise of a therapist and the time they spend to understand each patient’s unique needs. Rehabilitation robotic therapy needs to be administered by a trained therapist with specialised clinical and technical know-how. A therapist must be vigilant and observant about a patient’s unique condition and needs before setting appropriate training parameters on a rehabilitation device or system, and customising the rehabilitation therapy to optimise patients' functional recovery. Adoption of a high-tech, high-touch approach is key to helping patients recover optimally.
Year 4 Physiotherapy students Darryl Quek Xiu Hong (left photo) and Chong Jia Yun (right photo) demonstrating how the HandyRehab™ and Robotic Upper Limb Exoskeleton Suit can be used. (Photo: Wee Seng Kwee)
A/Prof Wee’s network of industry partners enables him to borrow different rehabilitation robotic prototypes and commericalised products, virtual reality systems, and wearable sensors for his research. In the meantime, companies can use the research data and clinical expertise from SIT’s researchers to refine and improve their products for better usability and comfort for people with disabilities.
(Left photo) A/Prof Wee Seng Kwee demonstrates how rehabilitation robots can help a user grip a water bottle to take a drink of water. (Right photo) Year 4 Physiotherapy students (L to R) Joyce Foo Ming Yen, Darryl Quek Xiu Hong, Chong Jia Yun and Lee Shi Hwee will be conducting research with A/Prof Wee Seng Kwee (centre) on the use of a Robotic Upper Limb Exoskeleton Suit to retrain paretic upper limb of stroke survivors. (Photo: Wee Seng Kwee)
There is also room for further research on combining the use of different rehabilitation technologies. A/Prof Wee came up with the concept of combining the Ekso UE by Ekso Bionics and HandyRehab™ to create a robotic upper limb exoskeleton suit for intensive upper limb rehabilitation. It may also be possible to leverage a brain computer interface (BCI) that can detect electroencephalography waves (i.e. brain waves), thereby allowing a patient’s intentions to activate the robotic exoskeleton that enables body movements.
A/Prof Wee stresses that SIT’s collaboration with the industry is more than just test-bedding products – it also provides an opportunity to benefit persons with disabilities and the elderly in the community. He hopes to continue giving his students as much exposure as possible to the cutting-edge technology available on the market. By doing so, they are less likely to be intimidated when confronted with technology in their future workplace.
He said, “I would like to motivate our students to be early adopters and advocates of such rehabilitation technology to complement conventional rehabilitation therapy. Combinatory rehabilitation approaches will not only aid in optimising patients’ recovery, training with rehabilitation technology can be fun, interactive, and engaging. And, I would also like to see SIT graduates become the best therapists in the field who provide innovative, evidence-based care for all the clients they serve and improve their quality of life.”