Rehabilitation: A mix of conventional and robot-assisted therapy leads to success

The rehabilitation sector increasingly uses robot-assisted or technology-based assistance systems to perform the often repetitive exercises and support and motivate patients to keep up with the arduous therapies. This boosts progress in rehabilitation and enables patients to live a self-determined life after rehabilitation – holding true to the motto, "Rehabilitation before long-term care".

REHACARE.com asked the RehaCentrum Hamburg about the advantages of robot-assisted therapy in the rehabilitation sector and inquired how well human-machine interaction works in everyday rehabilitation.

Dr. Bender, you are the Medical Director and Chief Physician of the Neurological Rehabilitation Department at the RehaCentrum Hamburg. How has rehabilitation changed in recent years?

Dr. Gabriele Bender: Neurological rehabilitation has rapidly gained importance over the past few years. This is primarily due to therapeutic advances in neurology and neurological rehabilitation, as well as the rising number of patients. Neurological rehabilitation has recognized the significance of neuroplasticity in the implementation of therapeutic concepts. This is why new therapeutic solutions and particularly technical processes or robot-assisted systems were further developed and increasingly introduced in rehabilitation facilities. In addition to traditional methods like the Bobath concept, PNF, Vojta, and other well-known techniques, rehabilitation facilities now increasingly add device-assisted therapies and therapeutic circuit training with repetitive task training.

Have patient expectations of respective rehabilitation measures changed?

Dr. Bender: Neurological patients have become better informed and are more discerning. That being said, family members often also become involved in the rehabilitation process right from the start. Prior to their rehabilitation session, both patients and family members can obtain information thanks to new media such as web presence of clinical facilities and available online information. Nevertheless, expectations of rehabilitation patients are often too high and unrealistic. Many patients think they will be completely recovered or much better after rehabilitation. However, this is often unattainable due to the severity of a neurological disorder. Many neurological disorders require continued outpatient treatment over several months or years even after patients have undergone rehabilitation.

What are the advantages of robot-assisted therapy in the rehabilitation sector?

Dr. Bender: Robot-assisted therapy complements the existing conventional therapy approaches and often increases a patient’s motivation over a long-term rehabilitation program. Robot-assisted therapy processes by no means replace conventional physical and occupational therapy approaches (such as Bobath, PNF, Vojta etc.). Unfortunately, a major drawback of robot-assisted approaches is the fact that the devices are very expensive, which is why many rehabilitation facilities are unable to afford them. Occupational and physical therapy offices are likewise typically unable to buy this type of equipment.

The RehaCentrum Hamburg uses the Armeo system by Hocoma. What is Armeo and how does it work?

Dr. Bender: The Armeo Therapy Concept is designed for patients who suffer from injuries as a result of a stroke, traumatic brain injury or other neurological disorders, which – among other things - leads to loss of hand and arm functions. Studies show that acute, repetitive and task-oriented therapeutic exercises have a very positive impact on the affected arms and recovery of ability and function when combined with a technological aid/therapeutic device. There are three Armeo therapy devices. ArmeoPower is a robotic arm exoskeleton, which electromechanically fully supports the weight of the affected arm, even if it shows no activity. The ArmeoSpring system is an ergonomically designed arm brace ("metal arm") with a spring mechanism. Patients must be able to actively move the arm since they have to guide and control the "metal arm" themselves. The ArmeoBoom therapy concept features a sling suspension system with arm weight support. Patients can freely move their arm in a sling to perform exercises. All three Armeo systems are connected to a computer and give an illustration (visualization) of the movements on the screen. The device manufacturer offers interesting computer games in the software program, which boost the patient’s motivation. Computer software also provides feedback to the patient and therapist on the progress of performed exercises.

How effective is the Armeo Therapy Concept compared to conventional rehabilitation therapies?

Dr. Bender: Based on my experience, the Armeo Therapy Concept can speed up the recovery process when it is used in addition to the conventional therapy strategies offered by a rehabilitation facility. I believe the Armeo Therapy Concept is on par with the conventional physical and occupational treatment concepts as it pertains to the effectiveness of regaining movement in a paralyzed arm. Having said that, the training intensity with the Armeo technique (depending on how the exercise is completed) can be somewhat greater than is the case with conventional methods.

What does modern rehabilitation mean to you?

In my opinion, modern rehabilitation includes an interdisciplinary treatment by several highly skilled professionals (physicians, nursing staff, occupational therapy, physical therapy, speech therapy, neuropsychology and social services), complemented by physical measures. The therapy concepts must be tailored to the individual patient and continuously adapted over the course of weeks and months. In my view, a combination of conventional therapy methods and modern technical or electromechanical devices is the most promising method to achieve a successful rehabilitation outcome.