New Medical Technologies in rehabilitations robotics: Experience from Slovenia Zlatko Matjačić University rehabilitation institute Ljubljana, SLOVENIA

Prof. Zlatko Matjačić

Background Ageing society – increased need for efficient rehabilitation Budgetary constraints – limited institutional rehabilitation facilities Rehabilitation robotics may increase productivity of rehabilitation treatment

Rehabilitation robotics – current situation Complex systems with many DOFs – large investment costs Require substantial donning/doffing time/procedures Application limited to larger rehabilitation centres

Efficacy of rehabilitation robotics Large-scale clinical trials are only few, rather expensive and lack conclusive evidence (due to heterogenity of patients large experimental and control groups are needed) This significantly impedes wide-spreading of rehabilitation robotics to the markets and consequently to clinical environment

An alternative approach Most of current rehabilitation robots originated from research done at universities – over-engineered devices Relevant clinical needs may be adequately addressed with one or at most two DOFs devices – simple rehabilitation robots

Simple rehabilitation robots Advantages: Smaller development costs Shorter time-to-reach market Affordable end price sustainable also for smaller private therapy practices This may result in increased numbers of such devices in clinical practice -> may facilitate in increase of a number of clinical trials -> larger clinical experience & more conclusive evidence

Simple rehabilitation robots – examples from Slovenia Device for training balance during standing - Balance trainer Device for training balance during walking – e-Go Device for training standing-up – Sit-to-stand trainer Device for arm reaching and wrist movement training – Universal haptic drive Device for bilateral arm training – Linear Elliptical Circular Trainer

Balance Trainer Zlatko Matjačić, Thomas Sinkjær, Balance Re-trainer, United States Patent, US 7,086,996, 2006; European Patent, EP , 2008.

E-Go Zlatko Matjačić, Thomas Sinkjær, Balance Re-trainer, United States Patent, US 7,086,996, 2006; European Patent, EP , 2008.

Sit-to-stand trainer J. Oblak, Z. Matjačić, Aufstehtrainer, Deutsche Patent, DE B4, 2013.

MATJAČIĆ, Zlatko, CIKAJLO, Imre, OBLAK, Jakob. Universal haptic drive system : European patent EP B1, 2015; United States patent US 9,233,046 B2, Universal haptic drive

Linear-elliptical-circular trainer Jakob Oblak, Zlatko Matjačić, Treningsgerat, Deutsche Patent DE B3, 2013.

Instead of conclusion Simple rehabilitation robots: Control (should be biologically inspired) Mechanism design (with only few DOFs it is possible to cover a large portion of patients needs) Assessment (RCTs are not very well suited for rehabilitation but there are no better instruments) Reversed order of steps (prototype & limited testings -> product -> market -> clinical practice -> RCTs)

Thank you for your attention