World’s first wearable robotic device for stroke rehabilitation comes to Singapore

Aug. 26, 2012 - PRLog -- Good news for stroke patients in Singapore! Kinesis Physio & Rehab is bringing in two new innovations to Singapore, which focus on stroke rehabilitation. The first is the Tibion® Bionic Leg - the world’s first wearable robotic device to aid stroke recovery. Stroke patients wear this device on their affected leg and work with a physiotherapist to perform exercises. This helps patients improve gait and balance, strengthen stance and enhance active motor learning. The second innovation is the ReJoyce Hand and Arm Rehabilitation system, which is a home-based therapy that can be supervised by therapists over the internet. The therapy involves a range of exercise games with adjustable difficulty levels, to maximise motor recovery of the hand, arm and shoulder. This is the first time that the Tibion Bionic Leg and ReJoyce Hand and Arm Rehabilitation system are being made available to the public in South East Asia, through Kinesis Physio & Rehab . (The Tibion Bionic Leg is developed by US-based company, Tibion, and was released in 2010. ReJoyce was developed by Canadian-based medical devices company, Rehabtronics, and released in 2011. This is the first time both products are made available in S.E. Asia.)

“Both the Tibion Bionic Leg and ReJoyce system work by encouraging stroke patients to repeat certain movements of their affected limbs in a regular and consistent manner. This supports the principles of neuroplasticity, which is the nervous system’s ability to renew and rewire itself, and this is crucial in recovering motor ability during stroke rehabilitation. At Kinesis Physio & Rehab, we combine the latest technologically-advanced equipment with our clinical experience, to offer optimal evidence-based solutions to help stroke patients regain mobility,” said Philippe Steiner, Chief Executive Officer, Kinesis Physio & Rehab.

Tibion Bionic Leg
This is a battery-powered robotic trainer consisting of a pressure-sensing shoe insert, motors to provide leg support, an angle sensor in the knee and a computer where the therapist can programme the level of intensity and monitor patients’ movements. Using the Tibion Bionic Leg, the patient initiates effort by applying weight to the affected foot/ leg.  Sensors within the device detect this force and motors support the affected leg, aiding the patient in his/ her ambulatory exercises. These exercises include moving from sitting-to-standing positions, overground walking and climbing up and down stairs. The physiotherapist alters the intensity of the therapy to ensure the patient works at optimal levels. As the patient’s strength and confidence increases, the physiotherapist reduces the level of assistance from the robotic device. Once the patient’s affected leg strength matches the unaffected leg, the patient continues exercises without intervention or assistance.

Advantages of the Tibion Bionic Leg include the following:
•   The wearable device provides therapy throughout the entire stroke recovery process from acute to post-acute and chronic stages.
•   This is a patient-intention activity, where the patient (and not the device or therapist) must initiate the effort.  As patients feel the support from the Tibion Bionic Leg, this reduces their fear of falling and encourages them to repeat ambulatory exercises, which is critical for neuroplasticity.
•   The sensor network and leg motors track patients’ motions and customises itself to their style of walking. As walking is a repetitive motion, this allows the computer to ‘think ahead’ to provide the expected assistance
•   Patients can practice exercises in a natural ambulatory environment. This moves away from fixed treadmills or devices that provide support from a single-point suspension. Patients can use the Tibion Bionic Leg in the clinic, either by itself or in combination with various other therapy tools as well as move to other locations, such as up and down stairs.
•   A number of clinical studies  have demonstrated how the Tibion Bionic Leg has helped stroke patients to improve their balance, gait and function performance.
For optimal results, Kinesis Physio & Rehab recommends stroke patients use the Tibion Bionic Leg consistently and frequently, at two to three times a week, for a minimum of 6 weeks. Ideally, this therapy would commence as soon after the stroke as possible, although therapists have seen positive results in patients several years post-stroke. Patients affected by other neurology conditions, such as traumatic brain injury, partial spinal cord injuries, multiple sclerosis and Parkinson’s disease, could also benefit from using the Tibion Bionic Leg.

ReJoyce Hand and Arm Rehabilitation system
This is a hand, arm and shoulder exercise therapy, delivered as a home-based service with supervision from a therapist via the Internet. The ReJoyce Manipulandum acts like a large joystick with features such as a gripper, peg, jar lid and door handle. Sensors in the device measure movements and forces applied by the patient. To motivate patients to use the ReJoyce Manipulandum in the right manner, the system runs a range of games on a computer laptop. To progress in these games, patients must carry out upper limb exercises that represent activities of daily life. The therapist adjusts the games’ difficulty levels, as the patient’s abilities improve.

Advantages of the ReJoyce Hand and Arm Rehabilitation system include the following:
•   ReJoyce is an intensive task-oriented exercise therapy for the hand, arm and shoulder that is ‘disguised’ as a fun and exciting game. As these computer games include target practice, car driving and pick-and-place games, patients often look forward to their therapy sessions.
•   As a tele-rehabilitation system, ReJoyce is convenient for stroke patients who may not be able to travel to the clinic easily on a weekly basis. Patients from regional countries can benefit from this therapy, without having to travel to Singapore.
•   The system includes a standardised hand and arm function test, so therapists can easily monitor the patients’ motor recovery in an objective manner.
•   ReJoyce can be used in combination with Functional Electrical Stimulation devices.
•   The ReJoyce system can be used both in the clinic and at home, tele-supervised over the internet, providing patients with different treatment options.
•   Clinical studies  have demonstrated that ReJoyce can be beneficial to patients with upper extremity paresis.
Kinesis Physio & Rehab recommends stroke patients use the ReJoyce Hand and Arm Rehabilitation system on a daily basis, with tele-supervised therapy sessions occurring once a week, for a minimum of 6 weeks. In addition to stroke, the ReJoyce system could benefit individuals suffering from spinal cord injury or brain injury. See Annex A for a description of how the Tibion Bionic Leg and ReJoyce Hand and Arm Rehabilitation system have benefited patients in Singapore.

“Stroke is one of the leading factors of morbidity and mortality in Singapore. Due to Singapore’s ageing population, stroke rehabilitation becomes more important now than ever. With conventional stroke rehabilitative therapies, patients perform simple motor tasks repeatedly, which can be monotonous and affect compliance levels. The introduction of new advanced therapies can help stroke patients along their path of recovery in an engaging and progressive manner,” said Philippe Steiner.