A short history of rehabilitation robotics

robotic exoskeletons

The history of rehabilitation robotics dates back to the late 1950s, around the same time as the development of robotics itself. Initially, robotics focused on creating large manipulators to replace human workers in factories, specifically for dirty, dangerous, or undesirable tasks. During this time, the field of prosthetics and orthotics (P&O) played a significant role in the development of early rehabilitation robots.

Two notable examples were the Case Western University arm in the 1960s and the Rancho Los Amigos Golden Arm in the early 1970s. These devices were adaptations of mechanical arms designed as powered orthoses. The Golden Arm, for instance, was controlled by the user through a set of tongue-operated switches, allowing them to control each joint individually. Although functional, this method of endpoint control was cumbersome and challenging for the user.

In the mid-1970s, the Department of Veterans Affairs started funding a group at the Applied Physics Lab led by Seamone and Schmeisser. Their goal was to computerize an orthosis mounted on a workstation capable of performing activities of daily living (ADL) tasks, such as feeding a person or turning pages. This project marked a significant milestone by introducing a command-type interface, enabling a more comprehensive control system for rehabilitation robots. It moved beyond the joint-by-joint motion control to a more intuitive and versatile interface.

In addition to the advancements in prosthetics and orthotics, the 1970s also witnessed the development of the French Spartacus system, which was aimed at assisting individuals with high-level spinal cord injuries and children with cerebral palsy. Unlike the P&O-focused developments, the Spartacus system emerged from the French Atomic Energy Commission (CEA) and was initially used for nuclear fuel rod handling through large telemanipulators.

The Spartacus system was adapted to enable individuals with movement impairments to control it using a joystick, primarily for pick-and-place tasks. This system was not derived from the P&O field but instead built upon the existing technology used in nuclear applications. It was guided by the vision of Jean Vertut and played a significant role in the development of rehabilitation robotics.

Around a decade later, Hok Kwee, one of the researchers involved in the Spartacus project, initiated the MANUS project. The MANUS project represented a dedicated effort to create the first wheelchair-mounted manipulator explicitly designed as a rehabilitation robot rather than being adapted from another field or application. This marked a notable step forward in rehabilitation robotics, introducing a specialized device specifically tailored for rehabilitation purposes.

Amid these developments, several other significant programs were initiated. One notable program began in 1978 at Stanford University under the guidance of Larry Leifer. The vocational assistant robot program received long-term funding from the US Department of Veterans Affairs. Its objective was to create robotic systems to assist with vocational tasks.

Over several decades, the program resulted in the development of various versions of the desktop vocational assistant robot (DeVAR), the mobile vocational assistant robot (MoVAR), and finally, the professional vocational assistant robot (ProVAR). These robots underwent clinical testing and were designed to assist in vocational settings. The ProVAR, in particular, introduced an advanced feature that allowed users to program tasks using an easy-to-use browser-type environment.

The initial version, DeVAR, briefly entered the market in the early 1990s. However, multisite user testing revealed that it was still too costly, considering its functionality. As a result, the development shifted towards the ProVAR, with Machiel Van der Loos taking over the project. All versions of the vocational assistant robot were built upon the Puma-260 industrial manipulator to ensure robust and safe operation.

In 2006, the focus of the research shifted to the Veterans Affairs (VA) in Syracuse, NY. The aim was to integrate sensing and autonomous features into the robotic systems and explore more cost-effective manipulator options. This transition marked an important step in enhancing the capabilities and cost-effectiveness of rehabilitation robots.

In the mid-1980s, Tim Jones, working at Universal Machine Intelligence (later Oxford Intelligent Machines, OxIM) in the UK, recognized the limitations of existing industrial, educational, and orthosis-derived manipulators for rehabilitation. As a result, he embarked on an intensive effort to develop a dedicated workhorse system specifically designed for human service tasks within rehabilitation robotics.

Over ten years, a series of systems were developed, starting with the RTX model, which became widely used in research labs and clinics worldwide. These systems provided a much-needed solution for the rehabilitation robotics community, offering a platform tailored from the ground up to meet the requirements of human service tasks.

One country that extensively utilized the OxIM arm was France. Through a series of research projects funded by the French government and the European Research Commission, the OxIM arm was employed in developing and clinically testing workstation-based assistive systems. The projects initially began as the Robot for Assisting the Integration of the Disabled (RAID) and later evolved into the MASTER system.

When OxIM ceased the production of its arms, the French company Afma Robotics took over the responsibility of commercializing the MASTER system. They have continued to develop and market the system, with the commercialization efforts initiated in 2007.

The first commercially available feeding robot, called Handy-I, was developed in the UK. Mike Topping initially designed and commercialized it by Rehabilitation Robotics, Ltd. during the 1990s. The Handy-I robot aimed to provide individuals with cerebral palsy a means of achieving independence in feeding themselves. It was a well-received device known for its affordability. As users identified additional needs, the task environments of Handy-I expanded to include face washing and the application of cosmetics.

The history of mobile manipulator applications in rehabilitation robotics can be traced back to the 1980s when educational and industrial robots were adapted for such purposes. However, significant progress in this area came with the funding provided by the US National Institute on Disability and Rehabilitation Research (NIDRR) for a Rehabilitation Engineering Research Center on Rehabilitation Robotics (RERC) at the Alfred I. duPont Hospital in Delaware. This funding spanned from 1993 to 1997, enabling the RERC to support numerous research projects concurrently.

During this time, the RERC partnered with Applied Resources, Corp. (ARC), a local company specializing in rehabilitation technology products. The collaboration led to the development and commercialization of several products. Notably, Rich Mahoney, one of the researchers at the RERC, joined ARC and played a crucial role in expanding the company’s offerings to include the RAPTOR wheelchair-mounted arm.

The RAPTOR arm became an instrumental addition to ARC’s repertoire, further advancing the field of rehabilitation robotics by providing a wheelchair-mounted manipulator. This development allowed individuals with mobility impairments to benefit from the capabilities of robotic assistance.

In Europe, one of the most notable projects in the field of mobile manipulators was the MANUS project. Led by Hok Kwee at the Rehabilitation Research and Development Center (iRV) in the Netherlands, this project focused on developing a mobile manipulator specifically designed for wheelchair mounting. The system featured control through a joystick and provided feedback through a small display on the arm.

The MANUS project had a significant impact, leading to numerous subsequent research projects in the field. Importantly, it also resulted in the commercialization of the system by Exact Dynamics BV, a company based in the Netherlands. The commercialized version of the MANUS system has gained recognition and acceptance. In the Netherlands, it is free to eligible individuals with disabilities such as cerebral palsy or tetraplegia resulting from a spinal cord injury. The system is made available through physician prescription and supported by the Dutch government.

In the 1980s, the development of autonomous navigation systems for electric wheelchairs began, utilizing ultrasonic sensors initially designed by Polaroid Corporation for range finding in cameras. These sensors were inexpensive and small enough, with a diameter of 30 mm, to be placed around the periphery of a wheelchair. This allowed for medium-range navigation assistance, covering distances of approximately 10 to 500 cm.

During the 1990s and early 2000s, advancements in vision-based serving and laser range scanners further propelled the development of algorithms for faster, more intelligent, and less error-prone navigation and obstacle avoidance in electric wheelchairs. These research advances became prominent in this field.

In Korea, Zenn Bien at the Korea Advanced Institute for Science and Technology (KAIST) Human Welfare Robotics Center initiated the development of the KAIST Rehabilitation Engineering System (KARES) line of wheelchair-based navigation systems in the late 1990s. This project aimed to enhance the navigation capabilities of electric wheelchairs.

Similarly, at the University of Michigan, the NavChair project was launched, laying the foundation for developing the commercialized Hephaestus system at the University of Pittsburgh. These initiatives focused on improving the autonomous navigation abilities of wheelchairs, enabling users to maneuver in their environments more effectively and independently.

Therapy robots in rehabilitation had a later start compared to assistive robots. In the mid-1980s, early exercise devices like the BioDex marked the first step towards programmable and force-controlled devices, although they were limited to single-axis movements. Khalili and Zomlefer published the first multi-axis concept, and Robert Erlandson at Wayne State University developed and tested one of the first systems during the same period.

The RTX manipulator, featuring a touch-sensitive pad as an end-effector, was introduced in the mid-1980s by Robert Erlandson. This device presented targets at various locations for patients with upper-extremity weakness, such as those who had suffered a stroke. Patients were required to hit the targets after receiving a visual signal on the screen. The software recorded response times, providing a score that could be compared to previous sessions.

Later therapy robots incorporated advanced force-based control, which demanded more computational power. In the early 1990s, the MIT-MANUS Project, led by Neville Hogan and Igo Krebs, commenced. This was followed by the Palo Alto VA’s Mirror Image Movement Enabler (MIME) project and its derivative, the Driver’s Simulation Environment for Arm Therapy (SEAT), involving Charles Burgar, Machiel Van der Loos, and Peter Lum. The Rehabilitation Institute of Chicago’s ARM project, led by Zev Rymer and David Reinkensmeyer, also emerged during this time. These projects had a distinct approach to upper-extremity stroke therapy and successfully demonstrated their clinical effectiveness in different ways.

Cognitive robotics aimed at assisting children with communication and physical disorders began in the early 1980s, with a focus on enabling them to gain control over their physical environment. Educational manipulators were primarily used, leading to the development of several demonstration systems. In the early 2000s, Corinna Latham of Anthrotronix, Inc. commercialized small robot systems that allowed children with physical disabilities to engage in games through simple interfaces.

In autism therapy, Kerstin Dautenhahn’s group utilized small mobile robots in clinics to interact with children with autism. Due to the straightforward interfaces of robots, communication with them appeared to be less challenging for these children than interacting with other humans.

Additionally, the early 2000s witnessed the emergence of pet robots, including the Paro seal robot, which served as companions for children and the elderly confined to clinics, providing them with companionship in the absence of real-life interactions. These pet robots were designed to simulate social interactions and offer emotional support.

Advancements in materials, control software, increased robustness, and the miniaturization of sensors and actuators have contributed to the expanding applications of robotics in various fields. These technological advancements have allowed designers to explore new ways of utilizing mechatronics technology to enhance the well-being and quality of life of individuals with disabilities.