Those magnificent men and their flying machines

Abstract

INTRODUCTION I was inspired when I overheard, by chance, a conversation between the daughters of two subjects who had suffered strokes in the past year and were enrolled in my study at the Burke Rehabilitation Hospital (White Plains, New York). This study, performed in collaboration with my colleague Dr. Bruce Volpe, is sponsored by the National Institute of Child Health and Development/National Center for Medical Rehabilitation Research. While waiting for their loved ones to complete robotic sessions, one daughter confided to the other that her parents had had strokes 15 years apart and that she was quite impressed with the improved acute care her mother received. Then she reflected for a moment and, in a sad tone, observed that both parents' rehabilitation processes, however, were almost exactly the same. From her perspective, nothing had actually changed in that 15-year interval. She is right. So far, no magic bullet exists for rehabilitation following stroke. The last 75 years of rehabilitation practice and research have delivered few actual answers for ameliorating and maximizing favorable outcomes for stroke survivors. We have essentially perpetuated long-time rehabilitation practices, many of which fall more under the realm of art than science. However, looking into my crystal ball and moving the clock forward 14 years to 2020, I predict that the daughter's comments might be quite different then. Looking beyond the marble floors recently laid in every U.S. rehabilitation hospital, beyond the glass and glitter of the corridors and the amenities in patients' rooms, I am optimistic that we are at the cusp of a major transformation in physical medicine. New tools for novel neuroprotection agents, imaging techniques, robotics, electrical stimulation, neurostimulation, nerve growth factors, neurorecovery agents and, ultimately, neuron genesis and replacement will change the way we practice rehabilitation medicine and significantly raise our expectations from the present limited goal of disability management to an actual cure. Rehabilitation robotics is one agent of change that will be ready for full-scale deployment within the next year or two. True, if one's expectation of robotics is inspired by Commander Data of the television series Star Trek: The Next Generation or by movies such as Terminator, then we are still falling short of our actual capabilities. A much better rendering of what I expect to see in rehabilitation hospitals and wellness facilities is a gymnasium (gym) of robots. This gym would not be very distinct from today's top-of-the-line gyms except that robots would assist people with disabilities as appropriate, possibly via real-time sensing or imaging techniques. The clinician would choose the therapy goals and approach and then supervise or teach the patient how to achieve those goals. The patient would bring robotic tools home, and these robotic platforms would become the common denominator in the continuum of care that includes the acute facility, rehabilitation hospital, outpatient clinic, wellness center, and home. Envision the use of robotics moving beyond care: social environments could be established via the Internet and patients could interact, compete against one other, and thrive. 2020? AM I AN OPTIMIST? Prior to 1990, no articles on robotic therapy had been published. Of course, the application of robotics to rehabilitation has a longer history, but the strong and sustained growth of activity in recent years is the result of a significant shift away from assistive technology for people with disabilities (conceptually, smart versions of a crutch) toward robotic therapy that supports and enhances clinicians' productivity and effectiveness in facilitating patient recovery. The magnitude of this change goes far beyond the usual ebb-and-flow of activity in technology-related fields. For example, the approximate number of articles submitted to the biennial International Conference on Rehabilitation Robotics (ICORR) from 1997 to 2005 demonstrates a sharp upswing in interest in rehabilitation robotics. …