REST: Reconfigurable lower limb Exoskeleton for effective Stroke Treatment in residential settings

Lead Research Organisation: University of Leeds
Department Name: Electronic and Electrical Engineering

Abstract

According to the UK Guidelines for stroke rehabilitation, the national standard for stroke rehabilitation is at least 45 minutes per day of each relevant therapy for a minimum of 5 days per week to people who have the ability to participate. However, this standard has never been met due to the decreasing availability of rehabilitation services and increasing pressures on the NHS. In the UK, over 600,000 people with stroke live further than 20km from a stroke support group, the majority of whom live with severe mobility issues. It would be very challenging and costly, or even impossible for them to travel and receive rehabilitation treatments regularly in hospitals or rehabilitation centres. The NHS Five Year Forward View therefore made recommendations in 2017 to bring rehabilitation to people in their own homes and care homes.

People with stroke commonly experience post-stroke movement disorders, particularly weakness, disordered movement patterns, including post-stroke dystonia and spasticity. The majority of stroke patients are disabled and dependent on their family members or others for some or all of their daily living activities.

Leveraging our previous success in robotic exoskeletons, our ambition is to deliver innovative rehabilitation through exoskeletons that are modular and reconfigurable to meet individual needs, and have the required intelligence to monitor recovery, personalise treatments and deliver effective rehabilitation in patients' own homes. We will pursue this goal by: 1) introducing new soft muscles and novel reconfigurable robotic mechanisms for the lower limb exoskeletons, enabling them for home rehabilitation use and easy to manufacture, maintain and repair; 2) developing standardised exercise programmes, with innovative disability assessment methods and intelligent personalised treatment strategies. The intelligent lower limb exoskeleton controller will learn the patients' recovery status and continually update the rehabilitation strategy to meet the patients' changing needs and deliver the best possible outcome. Personalised treatment methods will be investigated to enable adaptive rehabilitation training for patients in their own homes; 3) evaluating the functionality, acceptability, robustness, reliability and sustainability of the robotic exoskeletons, initially in laboratory settings, and then in the Leeds Teaching Hospital rehabilitation service and residential settings; and 4) assembling the required pre-clinical documentation to initiate future clinical trials.

Our long-term goal is to develop a nationwide robot-assisted home-based rehabilitation programme, which builds upon the technology and the experimental evidence originated from this proposal. Our project partners Devices for Dignity (D4D), Steeper Group, DIH/Hocoma, AiTreat and the National Demonstration Centre for Rehabilitation at Leeds Teaching Hospital NHS Trust will provide adequate links and resources for this project. This project will establish a transferable technology for stroke survivors' rehabilitation at home, with a potential impact on millions of people in the UK and worldwide.

Planned Impact

Stroke remains a significant societal challenge in the UK and around the world. The potential benefit from home-based rehabilitation interventions is substantial, especially when set against the annual UK cost of stroke of £9 billion. It is also predicted that there will be a 59% rise in the number of people suffering a stroke over the next 20 years, imposing unprecedented pressure on the NHS. This project aims to develop distinctive science and technology for enhancing the outcome and effectiveness of robot-assisted treatment in residential settings, it aligns perfectly with the NHS Five Year Forward View in 2017 to bring rehabilitation to people in their own homes and care homes. In addition to the academic impact, other beneficiaries of this project will include:

Economic benefit and emerging industries: Robotics and Autonomous Systems (RAS) is one of the 'Eight Great Technologies' identified by the UK Government in 2012. The government also recognises the need to build on the local and national investment to support this technology and to raise the profile internationally of the UK's world-class position in robotics. It has also confirmed that it will implement the creation of a Robotics and Autonomous Systems Leadership Council to enable industry, academia and government to collaborate on the planning and execution of the RAS strategy in 2015. It is predicted that RAS technologies can have a potential global economic impact of $1.9 to $6.4 trillion by 2025, via increasing the UK's health care productivity and reducing the total expenditure on long term care requirements of the UK's ageing population. It is predicted that RAS technologies could have a potential global economic impact of $1.9 to $6.4 trillion by 2025, while rehabilitation robot market size at $43.3 million in 2014 is expected grow dramatically to reach $1.8 billion by 2020. The REST project will capture and expand the current rehabilitation robotics market by providing solutions for stroke treatment in residential settings. It will contribute to the UK's ambition to become the world leader in Robotics and Autonomous Systems, and enhance the competitiveness of related healthcare industries, especially home and community based healthcare.

Societal benefit: The most important beneficiaries of this research will be the huge number of people with stroke and their families. Currently, there are over 1.2M living with stroke in the UK with 152,000 people sustaining a new stroke each year. It is predicted that there will be a 59% rise in the number of people living with a stroke over the next 20 years. Individual participants will benefit through their engagement in this project, which is an acknowledged benefit of participation in healthcare research, whether through the focus groups or the pilot studies. The impact on the wider community of people with stroke will be immense, with the ability to perform increased rehabilitation at home leading to improved outcomes and potentially earlier discharge from hospital, with benefits to the wider health and social care. Stroke patients' families will have less pressure to provide day-to-day care, reducing their burden to provide adequate care, which will result in further social care benefits. Although the project is a direct response to the World Health Organization's appeal on "Stroke: a global response is needed for stroke", the outcome of the project is not limited to stroke. It will benefit hundreds of millions of patients with lower limb disability in the UK and worldwide, including individuals with brain and spinal cord injury, people with multiple sclerosis, survivors of polio infections and children with cerebral palsy.

We have designed a comprehensive program of dissemination across a wide range of platforms promoting cross-disciplinary knowledge exchange, such as patient engagement, public awareness, academic dissemination and IP translation. Please refer to Pathway to Impact for more details.
 
Description Robot-assisted treatment strategy. We have developed a model-free adaptive iterative learning method to control the pneumatic muscles of an ankle rehabilitation exoskeleton. The pneumatic muscles work as actuators to enable the exoskeleton to provide rotational rehabilitation exercise. The pneumatic muscles can guarantee a safe patient-robot interaction due to its intrinsic compliance. However, the high nonlinearity of the pneumatic muscles makes the exoskeleton difficult to control. To solve this problem, we develop a pesudo-partial based updating law to estimate the dynamics of the pneumatic muscles in real-time according to the input-output data. Then an intelligent iterative learning algorithm is developed to estimate the patient-exoskeleton interaction force based on the estimated model. This approach is capable of regulating the assistance of exoskeleton so that the patient only get help when they cannot accomplish the rehabilitation tasks. To verify the approach we developed, a Labview based ankle rehabilitation testbed has been built. Our most recent results show that using this approach, the exoskeleton driven by pneumatic muscles can deliver more precise ankle rehabilitation exercise than the traditional method.
Exploitation Route This project will have a wide impact across robotics, industry, and health professions, due to its interdisciplinary nature. The outcome of this project is not limited to stroke rehabilitation. It will potentially benefit a lot of people with disabilities in the UK. In order to maximise the impact of this research, we design the following three stages to explore the best ways for clinical trials and commercialisation: a pre-clinical stage, a clinical trial stage, and a commercialisation stage. For the first stage, we will encourage end-users (stroke patients) to play an active role in our research and also engage in the programme of public engagement events. For the second stage, we will pursue external funding to support clinical trials from charitable foundations, and from research councils. For the third stage, with the help of our industrial partner, we will coordination with university expertise in the field of commercialization and support in research and innovation service. This will facilitate and expedite the transfer of the research outcome from theory to practice.
Sectors Digital/Communication/Information Technologies (including Software),Electronics,Healthcare

 
Description Coordinate steering groups 
Organisation Device for Dignity MedTech Co-operative
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We collaborate with the steering group organized by Devices for Dignity to assess the regulatory requirements of rehabilitation technology we developed.
Collaborator Contribution Recruit stroke survivors to pilot test groups and provide specialists to make sure the developed system is compliant with assessment and trial requirement.
Impact A steering group including both stroke survivors, physiotherapists and multi-disciplinary researchers have been created.
Start Year 2019
 
Description King' College London - design of reconfigurable ankle exokeleton 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution We have provided the dynamics of our self-designed soft actuator. All these parameters will be used in the design process of the ankle exoskeleton prototypes.
Collaborator Contribution The King' College London has provided us with the 3D model of the ankle exoskeleton they designed. The model has 3 rotational degrees of freedom and the rotation centre of the exoskeleton is align with the rotation centre of the ankle joint. The model will be used to manufacture a prototype.
Impact A 3D model of ankle exoskeleton robots
Start Year 2019
 
Description Patient Focus Group 
Organisation Leeds Teaching Hospitals NHS Trust
Country United Kingdom 
Sector Public 
PI Contribution We have been working with physiotherapists from Leeds teaching hospital to transfer current clinical rehabilitation exercises to Labview-based library for robotic exosketon
Collaborator Contribution Leeds teaching hospital has provided physiotherapists to support the development of a rehabilitation exercise library for the robotic exoskeleton.
Impact No outputs to date.
Start Year 2019
 
Description Steeper: the manufacturing support 
Organisation Steeper Group
Country United Kingdom 
Sector Hospitals 
PI Contribution We have been working with the engineers from Steeper as collaborators providing then with intelligence about the new actuation and control techonologies arising from this project.
Collaborator Contribution Steeper Ltd has provided engineering support and access to the equipment facilities for the manufacturing of robotic orthosis.
Impact A knee exoskeleton prototype has been developed.
Start Year 2019
 
Description WHO Tongji hospital, Huazhong University of Science and Technology, China 
Organisation Tongji University Hospital
Country China 
Sector Hospitals 
PI Contribution The University of Leeds offers an ideal environment for prototyping of medical robots, with state-of-the-art technology and expertise in fabrication at the EPSRC National Facility for Innovative Robotic System (£5M). Long-established collaborations between the faculties of Engineering and Medicine and Health create a vibrant medical engineering community, capabilities for pre-clinical studies, support for large-scale clinical studies in the Leeds Clinical Trials Research Unit, extensive medical industry and healthcare community links, and expertise in medical device regulatory and commercialisation pathways at the EPSRC IKC in Medical Technologies.
Collaborator Contribution Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, China, is one of the best general hospital in China. The Department of Rehabilitation Medicine was one of the earliest departments of physical medicine and Rehabilitation in China. In 1990, it was recognized by the WHO as "the Collaborating Centre for Training and Research in Rehabilitation". The department is now equipped with the most advanced assessment and rehabilitation treatment equipment. The department also has a long history of collaboration with Asian governments (such as Hong Kong, Mongolia etc.) on stoke rehabilitation.
Impact The collaboration led to a network grant that was funded by the Academy of Medical Sciences Global Challenges Research Fund Networking Grant Scheme in 2019.
Start Year 2019
 
Description 2nd consumer research advisory meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact 10 people including 2 physiotherapists and 3 stroke survivors have attended the meeting. The user requirement of the reconfigurable exoskeleton and other healthcare technology have been collected
Year(s) Of Engagement Activity 2019
 
Description 2nd meet - REST research group 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact 20 researchers from the University of Leeds, King's College London and Leeds Teaching Hospital meet together and present the recent technical progress of the project. The physiotherapists from Leed Teaching Hospital gave some feedback about the robot design.
Year(s) Of Engagement Activity 2019
 
Description Consumer Research Advisory Group Meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact We co-organised a consumer research advisory group meeting including 3 physiotherapists and 4 stroke survivors at Leeds Centre for Integrated Living
Year(s) Of Engagement Activity 2019
 
Description Kick off meeting - REST research group 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact 6 people from the University of Leeds, Leed teaching Hospital, and King's College London have been invited. The different research tasks have been allocated during the meeting.
Year(s) Of Engagement Activity 2019