The Science Zone: How Robotics & VR Create the Best Conditions for Functional Gains

The latest blog in our Science Zone series has been written by our founder and Clinical Director, Chris Wynne to explore the issue of why its important to always have a functional goal in mind when we’re treating our patients and how movement, however small, can be converted to function.  We’ve also featured some interesting findings from the Cochrane Reviews which support the use of robotics and virtual reality to restore function…

I was presenting at a conference a couple of months ago when a case manager approached me and said that he’d had the opportunity to see some shiny new robots in a clinic and although they may look impressive, how can they be effective if patients are not practicing movements in a functional setting?

I thought it may warrant a short blog to explain how robotic rehabilitation is very much functional. For example, we often see patients who have a small amount of arm movement but when we first meet, they are unable to use that arm for function. As a result, that arm may remain dormant, without the opportunity to practice functional repetition.

However, for patients with some movement, sensors can be used to create an active outcome in a virtual reality world and with enough repetition, improve that movement to get over the threshold for function. What’s more, the sensors can be programmed to react to the amount of activity that the patient has. So, for example, even if there is only a flicker of movement, they can elicit a positive change on the computer and gradually build on improving function.

Don’t take our word for it though. Our approach is supported by the Cochrane Reviews, a systematic review of research in healthcare, recognised as producing reliable findings to inform decision making.

Lower Limb

For lower limb effectiveness, 62 trials were carried out involving 2500 patients following a stroke and robotic gait training produced the following results:

Walking improvements – Positive effect on gait speed, walking, distance and basic activities of daily living

Target Population – non-ambulatory patients in early rehabilitation benefit most from robot-assisted therapy

Dependency – every eighth dependency in walking could be avoided using robot-assisted training

Effectiveness – robotic therapy in combination with conventional therapy is more effective than physio alone without the higher risk of adverse effects

Upper Limb

Likewise for upper limb robotic rehabilitation, 45 trials were carried out involving 1500 stroke patients with the following results:

Effectiveness – significant improvements in activities of daily living, arm function and arm strength

Methodology – for the first time, quality of evidence was rated high

Intensity – robot-assisted training increases the intensity of arm therapy by providing more repetition in the same amount of time.

Setting – robot-assisted arm training was used in combination with conventional therapies.

And more recently, The national clinical guidelines for Stroke for (NICE, 2023) in the UK stated:

“People with some upper limb movement or impaired mobility or balance should be offered repetitive task practice as a principal rehabilitation approach in preference to other therapy approaches, including Bobath.”

To conclude, it is essential to have a functional goal in mind when embarking upon an intensive physiotherapy program. It is essential that the desired function is realistically achievable. However, it is not reasonable to expect that a person can merely start practicing that task, when they do not have the prerequisite neurological control to carry it out. The task needs to be broken down into component, manageable parts and repetitively practiced. This would otherwise be mundane and thankless, as small flickers of movement do not produce significant outcomes in the real world. Robotics and Virtual reality allow us to provide the best conditions with which to get functional gains. They may be shiny and new, but their virtues are far greater than just that.

Visit our website to find out more about our intensive rehabilitation technology and treatment programmes.