Improving the Efficiency of Robot-Mediated Rehabilitation by Using a New Organizational Model: An Observational Feasibility Study in an Italian Rehabilitation Center

Abstract

Featured Application: By using new organizational models, robotic rehabilitation can be sustainable; therefore, it is possible to provide high technological upper limb treatment to a high number of patients.Abstract: Robotic rehabilitation is a promising way to restore upper limb function, but new organizational models are crucial in order to improve its sustainability. We aimed to analyze the feasibility of a robot-Assisted REhabilitation Area (robotAREA) equipped with four devices, using a new organizational model in which one physiotherapist supervises up to four patients. In 33 days, 60 patients were treated in the robotAREA. Two hundred fifty-five rehabilitation sessions were analyzed, each including two, three, or four patients supervised by one physiotherapist (the R2, R3, and R4 group, respectively). For each session, the duration of (a) setup, (b) training, (c) supervision, (d) session closure, and participant satisfaction were measured. For each patient, upper limb impairment, disability, mobility, and comorbidity were recorded. The time of training in the R4 group was lower by only 2 and 3 min compared to the R2 and R3 groups, respectively, while the supervision significantly changed between the R2, R3, and R4 groups. No differences were observed in satisfaction. Moreover, according to the logistic regression analysis, when the mean disability of the group is moderate, four patients can be supervised by one physiotherapist. These results suggest that the proposed model is feasible, and the mean disability of the group could influence the proper physiotherapist/patient ratio.

Automated patient-robot assignment for a robotic rehabilitation gym: a simplified simulation model

“…First, the optimization is run with each patient individually (number of patients = 1) using objective function (17) to obtain that patient's maximum possible skill gain if they are the only patient in the gym. The optimization is then run for all patients together with a new objective function that aims to optimize total skill (19) gain relative to each patient's individual maximum possible gain:…”

“…We then applied the time-indexed model to a simple scenario (3 patients, 5 robots, 5 time steps, different skill curves) using the original objective function (17) and new functions (19) and (20). This resulted in the example skill gains shown in Fig.…”

“…In this four-device study, each therapist was assigned to supervise 3 patients, and the authors again emphasized that such group settings may allow new organizational models that are more cost-efficient than the traditional “one patient, one robot, one therapist” model [ 3 ]. An observational study by the same team suggested that a therapist may be able to effectively supervise up to four patients exercising with four robots [ 19 ].…”

Special Issue on “Human Health Engineering Volume II”

“…The 12 presented papers in this second volume are grouped according to their contributions to the main parts of the monitoring and control engineering scheme applied to human health applications, namely papers focusing on measuring/sensing of physiological variables [5][6][7][8], papers describing health monitoring applications [9][10][11][12], and finally, examples of control applications for human health [13][14][15][16]. As indicated by Aerts [1], it is envisioned that the field of human health engineering is complementary to the field of biomedical engineering as it not only contributes to developing technology for curing patients or supporting chronically ill people, but also covers applications on healthy humans (e.g., sports, sleep, and stress) and thus also focuses on disease prevention and optimizing human well-being more generally.…”

“…Guttiérez et al [15] reported about a serious game platform with haptic feedback and EMG monitoring developed for upper limb rehabilitation of spinal cord injury patients. Aprile et al [16] demonstrated the feasibility of optimising the efficiency of a robot-assisted rehabilitation area for restoring upper limb function, allowing one physiotherapist to supervise four patients.…”