Monday, July 17, 2017

New Developments in Robotics Rehabilitation


By Alind Sahay
Vice President
Noxilizer, Incorporated

Today, robots are present in a variety of application areas in the healthcare space – in surgery, pharmacy, rehabilitation, hospital services and many other areas.  This trend is more recent in the area of rehabilitation robotics but is accelerating and some market research reports are predicting over 20% year-over-year growth.

Rehabilitation robotic systems are used in order to restore function or to provide assistive motor and motion functions.  These robots are generally segmented into assistive robots, prosthetics, orthotics, therapeutic robots and exoskeleton robots.  Intuitively, it makes sense to use robots for rehabilitation therapy as there is need for repetitive motion which needs to be in a specified and controlled range to stimulate recovery and not cause damage.  Additionally, robots generally have feedback devices and can measure progress of recovery and can therefore be used by therapists to optimize settings for patient recovery.

Though the current market for rehabilitation robots is relatively small (a few hundred million) when compared to surgical robots (a few billion), this market is expected to grow rapidly with advances in sensor technology, processing power, robotic technology and the potential for use of Artificial Intelligence.  Therapeutic areas for rehab robots include a) acute and chronic neurological disorders arising from stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis etc. b) orthopedic rehabilitation and c) other non-neurological and non-orthopedic  areas.  A quick review of the incidence and prevalence of stroke on a worldwide basis indicates a potential for a significant multi-billion dollar market.  At this time, although there are some leading players in this space, there is no dominant player.

For stroke therapy, there is general clinical agreement that, at a minimum, the introduction of robotic systems into clinical practice is useful in promoting the standardization of treatment and cost-effective use of human resources.  There is sufficient clinical data that shows that early treatment and intense treatment is better for recovery from stroke – and deployment of robots has the potential to ensure proper early and intense treatment.  However, the current robotic devices are heavily task oriented and provide simple repetitive movement patterns.  There is significant research in the use of engaging games coupled with automation that has shown the possibility of further improving outcomes.  These games, by engaging the patient, provide the possibility of improved therapy compliance and also, by their very nature stimulate neurological recovery in ways that a repetitive movement pattern cannot.  Games, though need to be well designed for this purpose.  There are a number of research institutions that have designed such games and some well-funded spin-off companies based on this research.

As we look at the future, one key factor that is a barrier to adoption is the cost of these devices.  The more complex high-end robots in the neuro-rehab space may cost around $100,000 and some of the more sophisticated exoskeleton assisting devices may cost around $200,000.  To improve adoption these prices need to come down and/or more innovative business models need to be developed that reduce the cost of use to customers.  Within the U.S., re-imbursement models for rehabilitation treatment do not allow for direct payment of costly robotic systems, rather treatment costs have to be fitted within the Medicare re-imbursement models. A 1990 study estimates the total direct cost of stroke to be $40.6 B, split into 45% short-term care costs, 35% long-term ambulatory costs and 17.5% nursing home costs. With well-thought studies, it should be possible to generate evidence that long-term care costs will come down with improved recovery and capture part of the savings from cost-reduction to either insurance or to patients/family.

In addition, there appears to be significant opportunity for companies to launch products using strategies similar to gym equipment.  For clubs, equipment is generally higher end and economic models are based on membership dues.  Some more well-to-do customer buy equipment for home use.  Companies should explore this model (and some are beginning to do so) as the opportunity is large due to high numbers of chronic patients and the willingness to pay for lower ‘club’ dues rather than high therapist fees in a hospital setting.

Clinical data for the use of robotic systems for therapeutic and functional rehabilitation is promising.  Robotics intuitively makesense for systematic rehabilitation.Coupled with gaming, connectivity and artificial intelligence, robotic systems have the potential to make significant positive impact on the lives of patients and reduce the economic and social impact, specially, of neurological related issues.  In the long-term, costs will come down and businesses will come up with innovative economic models based to significantly drive adoption.

Alind Sahay is a research and development business leader and innovator with over 20 years experience developing and launching innovative medical devices for global markets, which includes over 12 years leading product development for image based robotics at Integrated Surgical Systems and navigation systems at GE Healthcare. His business development experience encompasses defining and executing on technology-based opportunities, including licensing and collaborations.

Currently, he is Vice President, Research and Development at Noxilizer. Previous positions include Program Director, Endo Health Solutions, where he was responsible for the complete research and development portfolio for the Healthronics product line and Director, Product Development at Terumo Cardiovascular Systems, where he managed new product development and line-extensions for cardiac pumping systems and associated disposables.

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