ICONE- Upper Extremity Robotic Rehabilitation Sstem

icone:

LEADING INNOVATION IN ROBOTIC REHABILITATION by Heaxel

What is icone

icone is the first cost-effective plug-and-play robotic platform for upper limb neuro-rehabilitation, cleared for out-of-hospital use.

icone is thus the ideal medical robotic system for chronic patients, allowing long term, intensive and engaging therapeutic sessions via exergames (exercises performed through video games). It is designed for post-acute & chronic post-stroke patients with needs for upper limb rehabilitation:

it is a unique, portable, all-in-one, plug-and-play, cloud-connected, compact rehabilitation robot certified also for non-hospital use and for use by non-clinicians.

icone delivers accessible high-quality therapy in four programmable modalities and it delivers relevant, quantitative patient performance feedback while minimizing operating and maintenance costs.

icone replicates the widest studied robotic rehabilitation protocols, delivering high quality haptic feedback while performing both kinematic and dynamic measures of patient’s movements.

Thanks to icone high-quality therapy can be brought closer to the patient - even at home - and for long periods of time so that therapy can be sustainably delivered throughout patient’s recovery.

The system proves to maintain high therapeutic standards while maximizing financial reward for rehabilitation centers and reducing costs for patients.

icone is different to the, less engaging, current standard of care which is non easily scalable, expensive and normally delivered for short periods of time after Patient’s acute phase.

It is also different to the comparable high quality robots that are less affordable, hardly accessible and often not approved for the use outside the hospital.

Adaptive mode: icone assists the patient’s movement by automatically adapting assistance (i.e. the time allotted to complete the movement and the rigidity of the haptic tunnel), in real-time, on the basis of the patient’s performance. In this way, the robot automatically selects the best therapy for the single patient.

Passive mode: icone does not assist nor opposes to the patient’s movement: this mode is also called «transparent mode».

All in one

The ICone is the only all-in-one and plug-and-play medical system supporting rehabilitation professionals in providing intensive treatments for neurological patients, even after hospital discharge.

New technology

Through interactive and engaging games, designed according to the latest scientific evidences about neuroplasticity stimulation, the ICone promotes active motor planning and generates adaptive force fields to provide assistance as needed.

Effective

Treatments are provided in the form of interactive games, which can be easily tailored on the patient needs using the touch interface. The therapy can be objectively assessed and the data collected in real-time can be remotely accessed.

Portable

The ICone is the perfect partner of rehabilitation professionals, wherever the patient is. ICone is the ideal solution for hospitals and clinics, as well as community centers, rehabilitation clinics, physiotherapy centers and gyms.

Programmable Exergames

The therapy is customized for the specific patient by the rehabilitation specialist (therapist or doctor), by selecting:

-The patient scenario (football game, bowling, curling or galaxy);

-The number of repetitions ( the number of reaching movements to perform);

-The modality of robot-patient interaction

Feeling the Patients: the haptic tunnel

icone assesses, in real time, patient’s movement quality and provides force feedback accordingly to correct the movement, as a therapist would do by accompanying the patient’s hand:

-if the patient stays on the trajectory, the robot is transparent and the end-effect or can be moved very easily (haptic tunnel);

- if the patient deviates too much from the right trajectory, the robot will gently push back the patient, correcting the movement:

- The higher the deviation, the higher the correcting force.

- The entity of the correcting force can be increased by the therapy

manager.

- The entity of deviation allowed, defined by width and resistance of the haptic tunnel, can be modified by the therapy manager - so that «staying on the trajectory» might be easier or more challeng ing for the patient.

Patient-Robot Interaction Modalities

Assistive mode: icone assists the patient, just in case he/she is not able to start the movement within the maximum time allotted to initiate the movement, and he/she moves too slowly with respect to the ideal trajectory.

The degree of assistance (i.e. the assistive force exerted by the robot) is selectable by the therapy manager (1: minimum resistance; 10: maximum resistance). Both the maximum time to start the movement and the maximum time to complete the movement can be selected by the therapy manager.

Resistive mode: icone opposes to the patient’s movement, challenging his/her with a more difficult environment, in a sort of «arm wrestling» exercise.

The intensity of resistance (i.e. the opposing force exerted by the robot) is selectable by the therapy manager (1: minimum resistance; 10: maximum resistance). This mode is for patients who are more advanced in the recovery process and need to improve their strength.

Summary

Technical details

• selectable interaction modalities: passive, active, assist-as-needed

• Active workspace: Φ 330 mm

• Reachable workspace: 400 x 440 mm

User defined features

• Target arm (left, right)

• Type of patient-robot interaction: assistive, resistive, adaptive, transparent.

• Interactive exergame scenarios

• Width of haptic tunnel (0 ÷ 30 mm)

• Tunnel resistance (50-350 N/m)

• Resistance level (0.5 ÷ 20 Ns/m)

• Number of repetitions per session (1 ÷ 1200)

• Time allotted for motion initiation (1.0÷ 10 s)

• Tolerance on hand position error (0.5 ÷ 25 mm)

• Maximum speed (200 ÷ 800 mm/s)

Damping

• Damping level (0.5 - 20.0 Ns/m)

• Time allotted to reach the target (2-25 s)

Human-robot interface

• Integrated 15.6’ multitouch screen

• Bluetooth connection for keyboard and mouse

• Medical grade ergonomic artificial leather handle

• Integrated arm support

On-board sensory system

• Force resolution: better than 0.2N

• Position resolution: better than 0.1 mm

Haptic properties

• Max output force: 45 N

• Force resolution: 1.1% FS

• Max end-effector speed: 0.8 m/s

Safety

• Redundant sensors with automatic check of data

consistency

• Overload protection

• Automatic speed limitation

• Damping virtual edges

Icone was developed based on the widest robot protocol studied for upper limb rehabilitation –

MIT-MANUS, now called InMotion ARM.

Both the American Heart Association and the Department of Defense (Veteran Affairs) cite the

InMotion robots (now the MIT-Manus is called InMotion ARM and is from bioniks labs), see here

https://www.bioniklabs.com/bionik-clinical-guidelines

- VA REFERENCE: Dept. of Veterans Affairs and Dept. of Defense, Management of Stroke

Rehabilitation Working Group. "VA/DoD Clinical Practice Guideline for the Management of Stroke

Rehabilitation, Guideline Summary." Washington, D.C.: Government Printing Office, October (2010)

Vers. 2.0, p. 37 URL: http://www.healthquality.va.gov.

- AHA REFERENCE: Miller, E.L., et al., on behalf of the American Heart Association Council on

Cardiovascular Nursing and the Stroke Council, "Comprehensive Overview of Nursing and

Interdisciplinary Rehabilitation Care of the Stroke Patient:

A Scientific Statement From the American Heart Association," Stroke, 41:2402-2448, (2010)

References:

Find below a partial list of the articles published on the MIT-Manus. We collected these references

from our Medical Science Liaison with the expectation to be used for business clarifications and to

be presented to decision makers. For this reason, we selected a few articles whose title is selfexplanatory,

and added a few comments (bold).

· Volpe, B.T., et al., "Intensive Sensorimotor arm training mediated by therapist or robot

improves hemiparesis in patients with chronic stroke," Neurorehabilitation and Neural

Repair 22:3:305-310 (2008)

· Electromechanical and Robot-Assisted ARM training for improving general activities of daily

leaving, arm function, and arm muscle strength after stroke." The cochrane Collaboration,

The Cochrane Library , 2012 issue 6

· Norouzi-Gheidari, N, et al., "Effects of Robot-Assisted Therapy on Stroke Rehabilitation in

Upper Limbs: Systematic Review and Meta-Analysis of the Literature," VA Journal of

Rehabilitation Research and Development, 49 (4) 479-496 (2012)

· Dipietro L, Krebs H.I, Volpe B.T, Stein J, Bever , S.TMernoff, Fasoli S.E, Hogan N "Learning, not

Adaptation, Characterizes Stroke Motor Recovery: Evidence from Kinematic Changes Induced

by Robot-Assisted Therapy in Trained and Untrained Task in the Same Workspace" IEEE Trans

Neural Syst Rehabil Eng. 2012 Jan;20(1):48-57. Epub 2011 Dec 16 --> this means with

the robot you really stimulate neuroplasticity and you are LEARNING, not just automatically

adapting to a new task. This means: 1) you will retain progress and 2) you will be able to

apply learned skills to other (new) tasks.

· Volpe, B.T., et al., "Robot Training Enhanced Motor Outcome in Patients with Stroke

maintained over 3 years, Neurology 534874-1876 (1999)

· Lo, A.C., et al., "Robot Assisted Therapy for Long-Term Upper-Limb Impairment After

Stroke, New England Journal of Medicine, 362(19):1772-83.

· Kwakkel, G., et al., "Effects of Robot-assisted therapy on upper limb recovery after stroke: A

Systematic Review, Neurorehabilitation and Neural Repair 22:2:111-121 (2008)

· MacClellan, L.R., et al., "Robotic Upper Extremity Neuro-Rehabilitation in Chronic Stroke

Patients, VA Journal of Rehabilitation Research and Development 42(6)717-722 (2005)

· Fasoli, S.D., et al., "Does Shorter-Rehabilitation Limit Potential Recovery Poststroke

- Neurorehabilitation & Neural Repair. 18 2:88-94 (2004) ---> Short answer: yes. Longer

rehabilitation with the robot leads to better motor outcomes.

· Ferraro, M., et al., "Robot Aided Sensorimotor Arm Training Improves Outcome in Patients

with Chronic Stroke, Neurology. 61:1604-1607 (2003)