This document discusses trends in rehabilitation and the role of technology. It notes an increasing prevalence of chronic disorders and rising healthcare costs. Rehabilitation aims to help people adapt and self-manage their conditions. Technology such as robotics, virtual reality, and assistive devices can help regain function and autonomy. The ability to adapt is key for both patients and rehabilitation technology. Technology should be affordable and support self-reliance and participation.

1. Rehabilitation and Technology
Care for the Future
J.S. (Hans) Rietman, MD, PhD
Professor in Rehabilitation Medicine and Technology
University of Twente / Roessingh Research and Development
President of the Netherlands Society of Rehabilitation Medicine
(NSRM)

2. Marlou van Rhijn
Rio Paralympics 2016 finals: 100 meter

3. Marlou van Rhijn
Rio finals100 meter (another view)

4. Position paper NSRM 2015
Actively towards self-management and autonomy
Trends
• Increase of prevalence of chronic
disorders in the Netherlands
– From 5,3 M (2011) to 7 M in 2030
– increase of years in discomfort
and multimorbidity
• a general rise in the burden of
disease
• Reduced ability to participate in the
work process
• Increased expenditure on healthcare

5. ICF
International Classification of Functioning, disability and health (ICF 2001)

6. New definition of Health?
Health:
The ability to adapt and self manage in the
face of social, physical and emotional
challenges of live.
Machteld Huber et al. 2011
6

7. "It is more important to know
what sort of person has a disease
than to know what sort of disease
a person has.”
Hippocrates

8. Environment
From Capacity to Performance
Personalized rehabilitation and complexity
Performance
H
i
g
h
L
o
w
Capacity

9. Rehabilitation technology
Robotics, virtual reality, gaming

10. Training with a walking robot
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11. Rehabilitation Technology
Prime minister

12. Rehabilitation = lifelong learning
12

13. Rehabilitation at home
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Storyboard: Claudia Henckel, MSc
Project aim - Storyboard
Juliet Haarman, thesis TIBAR 2017

14. TIBAR
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TIBAR Therapist Inspired Balance Assisting Robot

15. 15
Working principle of TIBAR

16. Validation in an outclinic physical therapist practice

17. Robotics for arm and hand training
Rehabilitation Games
Armeo Boom, Hocoma
Hand In Mind
(Eurostars: Bioservo, Hocoma, RRD)

18. Engagement / Commitment
• Commitment to therapy for children and
adults is essential for therapy dose
• Therapy compliance for home practice is
generally low
• Can interactive computer games (ICP)
increase commitment and thus therapy
compliance so that optimal therapy
dosage is achieved?
18

19. From Capacity to Performance

20. Assistive Devices
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• Supportive technical devices like
prostheses, orthoses and wheelchairs can
help to regain and remain functional
skills and tasks (performance)
• The interaction between the adaptive
ability of a person and the adaptive
capacity of the assistive device will define
the level of performance

21. Children and technology?
21

22. Context of technology?
22

23. Patient with an Amputation
A Symbiosis of Adaptation and Compensation
consequences for walking

24. Actuated prostheses
filling the gap between artificial limbs and real limbs?
Powerknee (Ossur)
Vanderbilt prosthesis
Biom (Hugh Herr, MIT)

25. Actuated knee and foot
Vanderbilt prosthesis
Actuatie voet en knie
Vanderbilt University, Nashville Tennessee

26. Interaction of adaptations
a learning process
26

27. Interaction of adaptations
high performance
27
Hugh Herr et al. Massachusetts Institute of Technology,

28. Performance
It’s not all about walking!
Marieke Kloosterman; Keep on Rolling; Functional evaluation of power-
assisted wheelchair use. (Thesis: 23 june 2016)

29. Summary
• Personal factors and environment factors are
decisive for the rehabilitation result
• The ability to adapt is essential for both the
patient/user and the (technical) environment.
• Rehabilitation technology has an important role
in regaining and maintaining the patient's self-
reliance.
• Rehabilitation technology should be affordable
for everyone. (So we have to make it cheaper!)
• There should be more awareness by policy
makers and insurance companies of the
important role of technology to esteem self-
management and autonomy of people with
disabilities
29

30. 30
Implementation of care technology

31. It’s certainly not only Technology!
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32. Thank you for
your attention