Robotic assisted rehabilitation

 Robotic assisted rehabilitation

Organisation     Don Carlo Gnocchi Foundation (FDG)
Innovation and Development Department
Target Group    Adults affected by neurological diseases (mainly Stroke, Multiple Sclerosis, Parkinson disease, Polyneuropathy) or orthopedic diseases, with involvement of the upper limb. Professionals involved: personnel involved in managing or coordinating rehabilitation processes (medical directors, coordinators of therapists etc.) and personnel involved in monitoring the use of resources and strategic decision making (directors of rehabilitation centres, management controller etc).
Description  FDG operates a network of 29 rehabilitation centres throughout Italy, overall serving about 9.000 patients daily in hospital, outpatient and home care. Recently, considerable work has been carried out to optimize rehabilitation processes and clinical protocols, in order to uniform them and achieve standardized procedures with objective measurement on their efficacy and efficiency.

Within this context, the robotic assisted rehabilitation was first implemented in 2015. Nowadays, nine FDG centres are equipped with robots able to deliver rehabilitation by exercise in augmented reality environment. To account for sustainability, an organizational model was developed that includes a therapist to monitor 1 to 4 patients working on robots within 45 minutes individual sessions. The introduction of this model into clinical practice brought about the need to review the management process.

Following a simulation considering the entire process, a scheduling system was developed, able to guarantee the saturation of the robots
during each slot of the day by selecting patients at different levels of impairment. Furthermore, a data centralization process was implemented by networking the robots within the Foundation’s IT infrastructure and aggregating their data into a central database.

Business intelligence dashboards have been purposely created to offer services to managers, clinicians and researchers. The dashboards allow controlling the use of resources and technologies by managers (see Attachment 1), monitoring the patients’ performances and generating reports (see Attachment 2) to be included in the patients’ clinical record; finally, they allow researchers to access anonymized
instrumental data and clinical scales for research purposes. This approach allowed to evaluate both the clinical efficacy and the process effectiveness, based on a large set of real‐world data (28.000+ treatments so far), in a value‐based healthcare perspective.

The data analysis system was first used to supervise a Multicenter Randomized Controlled Trial (see Attachment 3: 247 participants in 8 FDG centres along 18 months), which showed the efficacy of robotic rehabilitation for the upper limb treatment in subacute stroke patients (Trial registr.number: NCT02879279).

After the trial, the data monitoring system was used to monitor the follow‐up of robotic rehabilitation in the 9 FDG centers, showing an important increase of the robotic rehabilitation sessions (see Attachment 4). The centralized control of the robots’ operational activity also allowed to identify the centers where robots had not been used at their full potential, triggering training actions on clinical managers and operators.

Partners Nine Rehabilitation Centres of the Don Gnocchi Foundation: Milano IRCCS, Rovato, La Spezia, Fivizzano, Firenze, Roma SM Provvidenza, Roma SM Pace, Sant’Angelo dei Lombardi, Acerenza
Staff and Resources  Core group: 3 Engineers, 2 Physicists, 2 Physicians, 1 Physiotherapist
Acknowledgements: all medical doctors and therapist involved in the robotic assistive rehabilitation treatments of all nine centres
Duration 2 years (ongoing)
Budget FDG
Contact /more information Names: Furio Gramatica, Valerio Gower, Filippo Benetti, Irene Aprile, Marco Germanotta, Marta Beorchia
Contact Email: