The document provides a comprehensive overview of rehabilitation devices, focusing on the evolution of prosthetics, robotics, and neurorobotics within the field of orthopedic medicine. It discusses various prosthetic technologies, including myoelectric and bionic limbs, and highlights the integration of artificial intelligence and neural interfaces in improving motor function for individuals with disabilities. Additionally, it explores the implications of neuroprosthetics and robotic systems in enhancing rehabilitation outcomes and independence for patients with paralysis or limb loss.

1. Rehabilitation devices
Dr.Bhaskar Borgohain
MBBS (AMC), MS Ortho (Delhi Univ.),
DNB Ortho (NAMS),
AO Trauma Fellow, (Germany),
Arthroplasty Fellow (Computer Navigation)
Professor & Head
Deptt. of Orthopedics
NEIGRIHMS Shillong
www.neigrihms.gov.in

2. Evolution of Prosthetics
Ancient Egyptian Hand :1500 BC
Prosthetic Hook hand of Sailor : 4th Century
Prosthetic Hands of
Knights : 8th century

3. TERMINOLOGY
Rehab. Engineering
 PROSTHETICS
 ORTHOTICS
NEUROROBOTICS
 ROBOT
 ROBOTICS
 MECHATRONICS
 NEUROROBOTICS
 CYBORG

4. PROSTHETICS
 Branch of medicine that
deals with the
production and
application of artificial
body parts.
 Prosthesis is an
artificial device that
replaces a missing body
part lost
 ‘Artificial limb’
Silicone Partial Finger
Prosthesis
Mainly cosmetic purposes
Low functionality.

5. ORTHOTICS
 Branch that deals with
design, manufacture &
application of orthoses.
 Orthosis is an externally
applied device used to
modify the structural &
functional characteristics of
neuromuscular & skeletal
system.
 Splints : Supports a weak/
diseased limb.

6. ROBOT
Definition
A machine capable of carrying out a complex
series of actions automatically, especially one
programmable by a computer.
“Robot". Oxford Dictionaries. Retrieved 4 February 2011
A mechanical or virtual artificial agent.

7. ROBOTS
 Czech science fiction writer
Karel Čapek first used the
term in 1921. Play 'Rossum's
Universal Robots'
R.U.R.(1920).
 Etymology: From Czech
word Robota 'forced labour'.
 Robots inspired by nature:
Field of Bio-inspired robotics.
 These robots created a new
branch of robotics: Soft
robotics

8. Mimicry benefitted mankind
The Wright brothers learnt a lot from the birds

9. Modern artificial limb
LondonOlympic2012,400mheat
Blade runner Oscar Pistorius makes history:
Finished 2nd in 45.44 seconds to reach the semi-final.
Biomimicry
Cheetah Flex Foot
The J-shaped Carbon
Blades designed by Ossur

10. Osseo integrated Finger Prosthesis

11. Evolution of Prosthetics ( Upper Extremity)
Myo-electric Prosthesis

12. ADVANCED PROSTHESIS & ORTHOSIS
 Manual/ Body-Powered Prosthesis
 Myoelectric prosthesis
 FES devices
 Robotic & Bionic arm
 Neural prosthesis

13. Robotics
The branch of technology that deals with the design,
construction, operation & application of robots as well as
computer systems for their control, sensory feedback &
information processing.
“Robotics". Oxford Dictionaries. Retrieved 4 February 2011

14. Mechatronics
It is a design process
that includes a
combination
of Engineering:
Mechanical, electrical,
telecomm., Computer &
Control engineering

15. The study of
how neural systems can
be embodied & movements
emulated in mechanical machines.

16. NEUROROBOTICS
 A neurobot (NR) is a mechatronic wearable robot
that can be applied to drive a paralyzed limb.
 Neurorobots are typically used to study motor
control & locomotion, learning & memory
selection, and value systems & action selection.
 Neurorobotics is an approach to robot control
through the use of neural networks.
- A Robot Model of Dynamic Appraisal and Response

17. Brainmapping:eeg
Cortical control areas of the brain

18. Brainmachineinterface
Deciphering the brain signals

19. Cyborg
A Fictional or hypothetical
person whose physical
abilities are extended
beyond normal human
limitations by mechanical
elements built into the
body

20. Bio-mimicry is not easy
Brain is a complex supercomputer to emulate
Conventional engineering has limitations
Engineers often end up making less complex, yet imperfect machines

21. NEUROROBOTICS: BRAIN MACHINE INTERFACE
 A combined study of Neuroscience, Robotics &
Artificial Intelligence, is the science and technology of
embodied autonomous neural systems.
(Embodied : To give tangible or visible/human form/shape )
 The robotic arm can be controlled both physically by
the patient’s amputed stump as well as electronically
using electromyography (EMG) muscle sensors.
 Additional component/components may “appreciate”
to certain stimuli and may respond & improvise.

22. AI: Artificial Intelligence
The theory & development of computer systems able to perform tasks
normally requiring human intelligence, such as visual perception, speech
recognition, decision-making & translation between languages.
“Artificial intelligence". Oxford Dictionaries. Retrieved 4 February 2011

23. Neural engineering & Neurorobotics
 Neural engineers try to solve design problems at the
interface of living neural tissue & non-living
constructs.
 Use engineering techniques to understand, repair,
replace or enhance properties of neural systems and
exploit these properties for design optimization.
 Neurorobotics try to create & optimize a tangible
autonomous neural systems.

24. Neural systems in Neurorobotics
 Neural systems include brain-inspired algorithms (e.g.
connectionist networks), computational models of
biological neural networks (e.g. artificial spiking neural
networks, large-scale simulations of neural
microcircuits) and actual biological systems
(e.g. in vivo and in vitro neural nets).
 Such neural systems can be embodied in machines with
mechanic or any other forms of physical actuation.
 This includes robots, prosthetic or wearable systems but
at also, at smaller scale, micro-machines ETC.

25. The basics of neurorobotics:
The brain machine interface

26. PRINCIPLES OF NEUROROBOTICS
 Through application of controllable forces, NR can
assist, replace or retrain specific motor function.
 Robotic intervention in rehab. of motor disorders
( e.g. Stroke) has a potential to improve traditional
therapeutic interventions.
 Because of its flexibility, repeatability and
quantifiability, NRs is increasingly applied in
neuro-rehabilitation.

27. Biomimetic & bioinspired robotics
 The architechture of mamalian CNS ensures accurate
limb trajectory, motor learning , novel motor task , multi-
limb locomotion etc is a model for humanoid robot to
emulate
 The sensorimotor interface between cerebral cortex and
spinal cord plays a key role in novel skill formation and
motor learning
 An accurate understanding of the sensorimotor
interfaces will give insight to basis of the algorithms
needed for adaptive motor learning

28. Hybrid system: Wide application
 Combination of NRs with functional electrical
stimulation (FES) therapy is a trend to overcome
many practical limitations
 Hybrid systems ensure widespread application of
NRs in clinical settings and motor control.
 Motor learning principles, robotic control
approaches

29. “Myoelectric" control system
 A state-of-the-art technology which uses electrodes to pick up
nerve signals from existing muscles in the stump.

31. Invasive approaches
 Electrodes can be permanently implanted in nerves and
muscles of an amputee to directly control an arm
prosthesis.
 It allows natural control of an advanced robotic
prosthesis, close to natural limb motion.
 With implanted electrodes, more signals can be
retrieved, and therefore control of more movements is
possible.
 Furthermore, it is also possible to provide natural
perception or “feeling”, through neural stimulation

33. BIONIC ARM
 Soldier injured in Afghanistan becomes first
Briton to be given bionic arm he can control
with his BRAIN

34. Evolution of Prosthetics ( Upper Extremity)
Touch Bionics: Hands of the Present

35. Brain-Machine interface (BMIc)
 Reaching & grasping in primates depend on coordination of neural
activity in frontoparietal area/unit.
 Primates can learn to reach & grasp virtual objects by controlling a
robot arm through a closed-loop BMIc that uses multiple mathematical
models to extract motor parameters * from electrical activity of fronto-
parietal neuronal Units.
* Hand position, velocity, gripping force & EMGs of multiple arm muscles
 As single neurons typically contribute to the encoding of several motor
parameters, high BMIc accuracy required recording from large
neuronal unit

37. Continuous BMIc operation
Jose M Carmena, Mikhail A Lebedev, Roy E Crist PLoS Biol. Nov 2003; 1(2): e42.
 by monkeys led to improvements
in both model predictions and
behavioral performance.
 Using visual feedback, monkeys
succeeded in producing reach-
and-grasp movements in robot
even when their arms did not
move.
 Learning to operate the BMIc
was analogous to functional
reorganization in multiple
cortical areas (Brain)
 Suggesting that the dynamic
properties of the BMIc are
incorporated into motor and
sensory cortical representations.

38. Optimizing a linear algorithm for real-time robotic control
using continuous cortical activity recordings in monkeys.
 Development of clinically useful cortical prosthetic devices
aimed at restoring motor functions in severely paralyzed
patients.
 Lab. work demonstrated that simple linear model
can be used to translate cortical neuronal activity into real-time motor
control commands that allow a robot arm to mimic the intended hand
movements of trained primates.
Wessberg J, Nicolelis MA : J Cogn Neurosci . 2004;16(6):1022-35.
Optimizing a linear algorithm for real-time robotic control using chronic
cortical ensemble recordings in monkeys.

39. Algorithms to predict hand kinematics from neural activity
 Only a small amount of data from a limited number of cortical
neurons appears to be necessary to construct robust models to
predict kinematic parameters for the subsequent hours.
 Motor-control signals derived from neurons in motor cortex can
be reliably acquired for use in neural prosthetic devices.
 Adequate decoding models can be built rapidly from small
numbers of cells and maintained with daily calibration sessions.
Serruya M, Hatsopoulos N, Fellows M et al.
Robustness of neuroprosthetic decoding algorithms.
Biol. Cybern. 2003;88(3):219-28.

40. Neural Prosthesis in Tetraplegics
 Tetraplegia, also known as quadriplegia,
is paralysis caused by illness or injury to a human that
results in the partial or total loss of use of all their
limbs and torso. The loss is usually sensory and motor,
which means that both sensation and control are lost.
 Loss of hand and lower limb function can severely
limit one’s ability to live independently and retain
gainful employment post injury. Thus, the
development of treatments that lead to some
functional recovery for the patient has the potential to
significantly impact quality of life

41. Neural Prosthesis in Upper Limbs
 Functional electrical stimulation (FES) can be used to
successfully restore hand grasp in someone with an SCI at the
cervical (C) level [2–3].
 The implantable hand grasp neuroprosthesis, uses voluntary
movement retained by the subject to proportionally control
the degree of hand opening and closing as well as grasp force.
The device electrically activates paralyzed muscles by using
electrodes that are either implanted within or sutured to the
muscles in the hand and the forearm to provide two types of
grasping patterns a palmar grasp and a lateral pinch.
 Use of the neuroprosthesis provides patients with increased
grasp strength, enabling them to manipulate objects of
different sizes and weights, and thus increases independence
in activities of daily living

42. CYBORG : Giving hope to paralysis victims, a monkey feeds itself using the
power of thought

43. IMPLICATIONS
 The cyborg-like limb could radically change the
lives of amputees and victims of paralysis.
 Bomb disposal squad
 HAZMAT situation disaster management
 Space travel and aviation safety

44. Neuro-prosthetic system
Total paralysis: the quadriplegics
 The brain chip
technology BrainGate
 A paralysed person was
able to control a
computer mouse,
allowing him to check
email, change TV
channels and draw.
 American Matthew Nagle
was quadriplegic; used
BrainGate for 12 months

45. University of Pittsburgh School of Medicine

46. How the Neuro-prosthetic system works.
 Two silicon-substrate microelectrode arrays surgically
implanted in the motor cortex (upper right) allow
recordings of ensemble neuronal activity, which are
then translated into intended movement commands.
 This brain-derived information is conveyed to a shared
controller that integrates the participant’s intent,
robotic position feedback, and task-dependent
constraints.
 Using this bioinspired brain-machine interface, the
paralyzed woman could manipulate objects of various
shapes and sizes in a 3D workspace.

47. Stroke scenario: High B.P.
 Stroke frequently causes lasting motor
impairments that undermine independence.
 About 30–70% of survivors remain unable to
functionally use their paralytic upper extremities
 About 50% continue to exhibit upper extremity
weakness 6 months after stroke.

48. The Myomo e100
 It is a US FDA approved, lightweight (4 lb, 6 oz), wearable system that
continuously monitors surface EMG signals from either the belly of the
biceps brachii or the lateral head of the triceps.
 These signals control the powered neurorobotic orthosis and assist the
active muscle with movement of the paretic upper extremity.
 The EMG can also be used to provide passive assistance in the opposite
direction when the muscle being targeted relaxes (e.g., when the sensor is
on the biceps, the Myomo can provide assistance with elbow flexion when
the biceps are active, or assistance with passive elbow extension when the
biceps are relaxed).
 The EMG signals are filtered and processed to infer a desired joint torque.
 The signal processing of the measured surface EMG : By a system
comprises of ready made EMG sensors, analog signal–processing
components, and digital signal–processing components.
 The signal-processing algorithm enables bidirectional control at the elbow
into flexion or extension.

49. Partial Finger Prosthesis
 Partial finger Prosthesis: An injury such as a loss of
one finger is considered as a significant functional, life-
long deficiency(Michael& Buckner 1994).
 One way to restore the functionality of the lost digit is by
replacing the amputation with prosthesis
 Types : (A) Silicone Partial Finger Prosthesis
(B) Osseo integrated Finger Prosthesis

50. Robotic Aids in Lower limb Paralysis
 The limitations of therapist assisted treadmill training have
inspired a number of research groups to explore the use of
robots for providing the mechanical assistance necessary for
locomotor training.
 Robot-assisted locomotor therapy, if successful, would enable
delivery of locomotor training to much larger patient
populations.
 There are a number of robotic locomotor devices used in
research and in clinical studies, including the Pelvic Assist
Manipulator (PAM), the Lokomat, and the Mechanized Gait
Trainer (MGT)
 However, due to fundamental differences between robot-
assisted and traditional locomotor training, the clinical results
for the robotic devices have shown limited success

51. Robotic Aids in Lower limb Paralysis

52. Robotic Aids in Lower limb Paralysis
 A human therapist is able to adapt the assistance patterns to the
changing behavior of the patient’s limbs. The therapist’s hands can
accommodate and adapt both in the short-term (over the course of a
single movement) and in the long-term (over the course 6 of a
therapy session or longer). Underlying the short-term ability to
adapt is the smaller mechanical impedance, or equivalently, the
greater amount of compliance used by the therapist compared to a
robot.
 In part because the therapist uses a lower impedance to impose
motions on the patient’s lower limbs, he is better able to detect the
patient’s muscle action. The therapist can then respond by adapting
his assistance over time, gradually decreasing assistance as he
observes the muscle action increasing appropriately.
 The robot, unlike a human therapist, cannot easily accommodate
such modifications and progression on the part of the patient

53. Band of robotic musicians in Georgia , USA!
 Prof. Gil Weinberg built a band of robotic musicians in his
Georgia Tech lab.
 Recently, he’s created a robot that can be attached to
amputees, allowing its technology to be embedded into
humans.
 The robotic drumming prosthesis has motors that power
two drumsticks.

54. He can now flex his muscles (The Biceps) to send signals to
a computer, which tightens or loosens his drumstick.

55. Robotic Prosthesis Turns Drummer into a Three-Armed
Cyborg; March 10, 2014
 Jason Barnes: the amputee drummer essentially becomes a
cyborg
 Prof .Weinberg added the second stick and gave it a “musical
brain/mind” to listen to the music and match the rhythm
 This was possible with robotic synchronization technology for
time-sensitive operations

56. Robotic drumming prosthesis
 The first stick is controlled both physically by the
musicians’ arms and electronically using electromyography
(EMG) muscle sensors.
 The other stick “listens” to the music being played and
improvises. The robot that can be attached to amputees,
allowing its technology to be embedded into humans.

57. Neuroethology
 It is the evolutionary and comparative approach to the study of
animal behavior and its underlying mechanistic control by the
nervous system.
 This interdisciplinary branch of behavioral
neuroscience endeavors to understand how the central nervous
system translates biologically relevant stimuli into natural
behavior.
 Neuroethologists hope to uncover general principles of the
nervous system from the study of animals
 Bees, bats, migratory birds, rats, human!

58. Active touch sensing
 Active touch is a complex process
 The active nature of these movements entails precise control
of the sensory apparatus, task-specific movements all of
which maximizes sensory information from the environment.
 Biomimetic robots may exploit the information generated by
different movements to select the most “useful” movements
that maximize information to successfully discriminate
between different textures (Fishel and Loeb, 2012; Pape et al.,
2012) and are able to judge surface compliance (Su et al.,
2012).
 Active touch sensing from a variety of different perspectives
including behavioral, physiological, neuronal, computational,
and robotic.

59. Reward centre
 Approach to robot control through the use of neural
networks.
 Connectionist modelling of cognition is inspired by
the style of information processing which occurs in
the brain
 It is now possible to robot control an animal using
principles of bioinspired neurorobotics

60. Value and reward based learning in neurorobots
 It may lead to the development of improved learning systems in robots
and other autonomous agents.
 Value does need not be reward-based; curiosity, harm, novelty and
uncertainty can all carry a value signal.
 Robots used models of the dopaminergic system to reinforce behavior
that leads to rewards.
 Other systems that shape behavior are acetylcholine's effect on
attention, norepinephrine's effect on vigilance, and serotonin's effect on
impulsiveness, mood, and risk.
 hormonal systems such as oxytocin and its effect on trust constitute as
a value system.
- Jeffrey L. Krichmar, Florian Röhrbein
Front. Neurorobot., 13 September 2013 | doi: 10.3389/fnbot.2013.00013

61. Summary
 Neurorobotics is about studying & deciphering biological algorithms
in BMIc
 It is a hot & expanding branch linked to the multibillion dollar
human brain project
 A mechanical arm controlled by thought alone has been tested on
monkeys, who were able to use it to feed themselves.
 A mechanical arm controlled by thought alone is entering human
trials.
 The limb has a fully mobile shoulder and elbow, and a sensitive
'gripper' that mimics a human hand.
 A hair-thin microchip implanted in the brain is linked to a
sensor in the prosthetic, which 'reads' the signals sent by
neurons and reacts instantaneously.
 The cyborg-like robotic limb could radically change the lives of
amputees & victims of paralysis.

62. Epilogue I
 Device-driven Neurorobotic Approaches to address
neuromuscular impairments have been developed,
including upper extremity robotic systems.
 Existing robotic strategies targeting the paretic upper
extremity are still somewhat limited by their efficacy,
portability & ability to be integrated into the day to day
complex “real world” upper extremity activities.
 Yet, current evidence supporting these systems is equivocal

63. Epilogue II
 Their cost & size limit widespread clinical &
domestic use.
 The future however looks quite optimistic
 It will be possible to feel sensation through
artificial limb
 A Paradigm shift is likely in the field of neuromuscular
rehab., once the technology becomes optimum, widely
available and affordable for common man

64. The future ahead
 Neurorobotics is one of the most ambitious fields in
robotics and will play a major role in the newly
announced Human Brain Project
 Work in neurorobotics will lay the foundations for a new
generation of computing systems and machines with
cognitive capabilities that are absent in current technology,
including a degree of autonomy and an ability to learn.
 This raises the issue of legal liability when a neurorobotic system
injures humans or their property – a topic already raised by the
advent of autonomous vehicles.

65. thankyou
Brainmachine interface