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Robotics in rehabilitation

Physiotherapist Jo Butchart and NAO. Credit: RCH/A
Photo: Physiotherapist Jo Butchart and NAO. Credit: RCH/Alvin Aquino
It stands just 58cm tall, talks, makes eye contact, sings and dances.

What’s more, NAO, the humanoid robot, is assisting young patients at Melbourne’s Royal Children’s Hospital (RCH) to complete their rehabilitation exercises.

While technology such as virtual reality and video games are increasingly being embraced in rehabilitation, NAO is believed to be the first robotic paediatric rehabilitation tool used in an Australian hospital.

With a unique combination of hardware and software, equipped with motion and sonar sensors, sound and vision tracking as well as voice recognition, Swinburne University computer scientists have developed software for the Brainary Interactive robot - enabling it to perform more than 20 rehabilitation exercises for patients with neurological or orthopaedic injuries.
Jo Butchart, a senior physiotherapist at RCH’s Victorian Paediatric Rehabilitation Service (VPRS), has worked with developers to program the robot with the range of strength training exercises, such as bridging and quads exercises.

Ms Butchart, an Australian Physiotherapy Association (APA) titled member in paediatrics, says the robot first started visiting the hospital with the team of Swinburne engineers about 18 months ago, after the project received a grant from the Transport Accident Commission (TAC).

“Initially it was getting to know him and what his capacities are and trying to think of how that might be useful in our setting,” she says.

“He spent some time just meeting a variety of kids and initially we were really just observing how the kids interacted with him, and how they felt about having a robot around in the clinic.

“He would do different little games and then we started to teach him some specific exercises and you would see kids walking past, get down, and try and copy what he was doing.”

NAO is still in its development stage. Physiotherapists are using the robot to assist children with cerebral palsy after gait correction surgery and to help children with spinal cord injuries.

NAO instructs children on how to perform each exercise and records their activity.

Most importantly, the robot also engages with children, providing motivation and encouragement with chatter, jokes, singing and dancing to pop songs, like Gangham Style.

Ms Butchart says NAO captures the attention of children and convinces them to get moving.

“As physios, we believe that the first part of someone improving in their rehab is actually committing to do the exercise - that’s really important,” she says.

“We need to find different ways to motivate children because they’re not going to understand the need to do the exercises the way that an adult might.

“There are a lot of bed-based exercises which can be quite boring for kids. To strengthen, you need to do the exercises multiple times - so often we’ll ask them to do between eight and 15 repetitions of the exercise several times a day.

“Having the robot with them and doing it with them, and telling them some jokes while they’re doing it, can make it more interesting and they can be a bit more motivated to do that.”

Ms Butchart says the robot is not a replacement for physiotherapists and other therapists. Instead, she believes NAO has the potential to augment therapy as a therapeutic aid.

There is also real potential for NAO to be used outside the hospital setting, assisting children to practice their exercises in their own home, she says.

“It’s about proceeding carefully because we want to use robots where they are useful but not have negative experiences, where we have expectations on robots to do things that actually need a high degree of clinical reasoning or thinking through,” she says.

“I can see that robots are going to be good at implementing quite routine, structured forms of therapy that are predictable but I think they are also going to need a clinician behind them, and maybe as a clinician we’re moving towards thinking about how can we do more with less time and what can a robot do for us?”

The NAO project team hopes to eventually compare rehabilitation outcomes for children with and without their robotic therapy assistant.

However, early indications reveal that using the robot with paediatric patients in rehabilitation is incredibly effective.

Ms Butchart says feedback from parents has been overwhelmingly positive. But it’s the hospital’s little patients who appreciate NAO the most.

“The best reaction is when the robot might be doing some bridges on the floor and the child gets down on the floor without me having to ask them to do that,” she says.

“We’ve seen kids be able to improve their attention, so they do more repetitions before trying to get up and do something else.

“But I have been a little surprised to see kids actually having conversations with the robot during the sessions,” she adds.

“They have so much enthusiasm and engagement with the robot.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords