Digital Medicine

EDITORIAL
Year
: 2019  |  Volume : 5  |  Issue : 1  |  Page : 1--2

In the era of digital medicine: Using technologies to restore functional movement in neurological patients. #Walking over disabilities


Paolo Milia, Marco Caserio, Mario Bigazzi 
 Prosperius Institute, Neurorehabilitation and Robotic Area, University of Perugia, Umbertide, Italy

Correspondence Address:
Paolo Milia
Prosperius Institute, Neurorehabilitation and Robotic Area, University of Perugia, Umbertide, Perugia
Italy




How to cite this article:
Milia P, Caserio M, Bigazzi M. In the era of digital medicine: Using technologies to restore functional movement in neurological patients. #Walking over disabilities.Digit Med 2019;5:1-2


How to cite this URL:
Milia P, Caserio M, Bigazzi M. In the era of digital medicine: Using technologies to restore functional movement in neurological patients. #Walking over disabilities. Digit Med [serial online] 2019 [cited 2019 Oct 17 ];5:1-2
Available from: http://www.digitmedicine.com/text.asp?2019/5/1/1/259310


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"Lo scopo dell'arte medica θ la salute, il fine ottenerla"

-Galeno

“…. Digital medicine is a scientific field, in which scientists seek to explain pathophysiological phenomena, solve medical problems, and explore new therapeutic procedures using modern digital technology, with the aim of improving the quality of human life…”[1] following the definition of Digital Medicine by Prof. Zhang and the Council members of the International Society of Digital Medicine, we have observed an impressive development of all the era of medicine improving both his aspects: diagnosis and treatment.

The recovery of patients affected by central nervous system (CNS) lesion is like a learning process exploiting preserved sensorimotor circuits. The best recovery is related by providing appropriate proprioceptive input to the spinal cord with the goal of maximally engaging preserved neural circuits. The extent of recovery depends on the severity of CNS damage and the individual capacity of a patient to regain a function.[2] Cognition and motivation are important contributors to this learning and must, therefore, be considered during rehabilitation. However, first of all, we need to understand that the goal of rehabilitation is not exclusively to reestablish “normal” movement patterns but to enable well-organized movements to achieve optimal outcome in mobility and independence during activities of daily living (ADL) for the individual patient.[3]

The last decades have seen rapid development of technologies for the rehabilitation of sensorimotor deficits in patients affected by neurological disorders. Robot-assisted therapy provides a number of advantages over conventional approaches, especially the opportunity to modulate intensity and dose combined with the improvements of patient.[4]

Robotic rehabilitation is a young science that is rapidly infiltrating the clinical environment. In 1994, with the development of MIT-MaNUS,[5] robotic device for the upper limb rehabilitation started the robotic era of neurorehabilitation. In the same year, the introduction of Lokomat,[6] a Body Weight-supported Treadmill Training assisted by a gait orthosis, represented the first pioneering grounded exoskeleton.

The exoskeleton is an outer wearable skeleton that allows people with paralysis of the lower limbs to walk. Neurological diseases such as traumatic brain injury, stroke, and spinal cord injury cause serious consequences both at physiological and motor levels. Our recent studies have underlined the positive effects of using exoskeletons both in spinal cord injuries and stroke patients, affecting in terms of positive results the two main domains of our brain: psychological and sensory motor.[7]

The better perception of the body using an exoskeleton gives an active physical engagement and contributes to achieve better improvement in mobility and independence during ADL.[8]

Following these main results, we developed a domestic program called Walking Over Disabilities,[9] where we have started to train our patients to a domestic use of the exoskeleton.

The project has been developed for spinal cord injury patients both clinically complete and incomplete.

The program is divided into 3 weeks, where the first week is focused on clinical and ethical aspects and the other 2 weeks are related with the real training program, where the patient is trained to use in a complete safe process the exoskeleton autonomously:

Donning and doffing the exoskeleton Wearing the exoskeleton on the wheelchair Gait training; the patient walks on different type of ground such as ramp and grass Safety: Training on different type of procedures such as falls Using the exoskeleton to come in and out from a car.

At the end of the program, the patient has to be confident and clinically adaptive to use the exoskeleton. A psychological screening to the patient and the caregiver is part of the training.

The last generation of exoskeleton is easy to use, light, and can be customized considering the clinical aspects of each patient. We cannot restore the physiological deambulation, but we can offer our patients the opportunity to be trained every day at home sparing time, money, and counteracting in this way, the secondary effects related with poor movement and sedentary. At the same time, patients have a different perspective of life starting again to walk over their own disabilities.

References

1Zhang S, Liao R, Alpert JS, Kong J, Spetzger U, Milia P, et al. Digital medicine: Emergence, definition, scope, and future. Digit Med 2018;4:1-4.
2Kwakkel G, Kollen B, Lindeman E. Understanding the pattern of functional recovery after stroke: Facts and theories. Restor Neurol Neurosci 2004;22:281-99.
3Latash M, Anson J. What are “normal movements” in atypic populations? Behav Brain Sci 1996;19:55-106.
4Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med 2010;362:1772-83.
5Krebs HI, Hogan N, Aisen ML, Volpe BT. Robot-aided neurorehabilitation. IEEE Trans Rehabil Eng 1998;6:75-87.
6Hesse S, Uhlenbrock D. A mechanized gait trainer for restoration of gait. J Rehabil Res Dev 2000;37:701-8.
7Milia P, De Salvo F, Caserio M, Cope T, Weber P, Santella C, et al. Neurorehabilitation in paraplegic patients with an active powered exoskeleton (Ekso). Digit Med 2016;2:163-8.
8Milia P, De Salvo F, Peccini MC, Sfaldaroli A, Cadri S, Caserio M, et al. Exoskeleton in the neurorehabilitation process: Neuropsychological effects in patients affected by spinal cord injury and stroke. Digit Med 2018;4:180-3.
9Domestic use of an exoskeleton in patients affected by spinal cord injuries. InnovaS@lute2017. Forum Innovazione per la Salute; 2017.