Podcast: Exoskeleton + Digital Twin Aid Stroke Recovery

In this episode, we explore a groundbreaking system developed by researchers at the Technical University of Munich that aids stroke patients in regaining arm and hand mobility. By integrating functional electrical stimulation with an exoskeleton and utilizing a digital twin for personalized therapy, this innovative approach offers new hope for faster and more effective stroke rehabilitation.

This podcast is sponsored by Mouser Electronics. 

Episode Notes

(2:30) - Regaining mobility quickly after a stroke

This episode was brought to you by Mouser, our favorite place to get electronics parts for any project, whether it be a hobby at home or a prototype for work. Click HERE to learn more about how wearable robotics is aiding Parkisons therapy!

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Transcript

Hey everyone, in today's episode we're talking about stroke recovery and how playing video games might help patients improve from strokes. Cool technology from Technical University of Munich that combines robotic arms with electrodes and a digital twin. It's pretty awesome, so let's jump right into it.

What's up friends, this is The Next Byte Podcast where one gentleman and one scholar explore the secret sauce behind cool tech and make it easy to understand.

Daniel: Hey folks, today we're talking about some pretty awesome developments from Technical University of Munich. They're making a tool to help stroke patients move their arms and hands better again. But before we jump too quick into that, I want to take a second to mention today's sponsor, Mouser Electronics. And if you've been listening to the podcast for a little while, you know that we appreciate the way that Mouser takes interesting technical topics, makes them easy to understand. We think it aligns pretty well with what our mission is on this podcast. And just another example of them doing that in an awesome way is the technical resource that we've got linked in today's show notes. It's about wearable robotics for Parkinson's mobility. Talking about soft robotic suits that can help reduce the freezing of gait symptoms that happen for patients that have Parkinson's disease. It helps assist their hip flexion, make sure that they can continue to walk. And pretty awesome, it's showed instantaneous walking improvements in several patients. You know, not something that takes a long time to learn before you get, the impacts. This thing, I was making an impact right away. It's talking about how you can use actuators, smart sensors, robotics, and then linking that all to a smart computer system to help improve mobility. It relates very heavily to what we're talking about today in terms of relearning movement after strokes, not necessarily continuing to support movement after Parkinson's, but lots of similar themes there. So, we thought it was an awesome article to link in the show notes.

Farbod: Totally. And pun intended, but this article is a great example of the range that Mouser has when it comes to their technical resources. Global distributor of electronic components, and they still have like great access to what's going on in the medical industry. So that's why we love them. Great segue into what we're talking about today. Take it away, Daniel.

Daniel: Awesome. Yeah. Well, check it out in the show notes if you're interested. Again, so back to today's topic and kind of zooming out to the overall problem, Nellie's aunt experienced a stroke recently and she's been dealing with a lot of these symptoms.

Farbod: I didn't know that.

Daniel: Definitely hits close to home, but stroke often leads to hemiparesis, which I'm going to define that term in a second, but it means that you've got paralysis or weakness on one side of the body. So, it makes lots of daily movements like grasping or lifting objects really, really challenging when you're recovering from a stroke. Lots of the current rehab approaches involve using physical therapy. They're slow. They're kind of a brute force. A brute force approach, I guess, is how I would recognize it. Lacks a lot of personalization. There's no like adaptive part of the rehabilitation. Imagine just like, that the way that you're told to rehab is by going home and doing like thousands of tennis ball grabs as the way to regain movement in your hand, as opposed to a system that can actively understand where your nervous system is working well, where your nervous system is not, augmenting your nervous system with certain stimuli to make sure that it works better. And then also providing external support as a scaffold that can help compensate for any weakness that you experience in your limbs. I'm kind of alluding to what the solution is here, but that's kind of the where we're at now. And I will say that hand movement in particular, as opposed to like large motor limb movement, your entire arm, your entire leg, hands are something that doctors actually say are one of the most challenging movements to recover because it's a lot of finesse, right? If you do something wrong with your hand to go pick up your phone off the table, as an example, it's really easy to drop it if your movement is hampered or delayed or weak in any way. So, they say the finesse movements like getting fine motor control of your hand back is actually one of the most challenging parts of stroke recovery for folks with hemiparesis. So, that was the focus of this research, which is creating a modular rehab system that involves electrical stimulation to help stimulate muscle strands to get the moving exoskeleton support to help support the limb in the weakness post stroke, as well as a computer system that it connects to help train the motor skills dynamically understanding what the user's ability is and then gamifying it so that it's fun to like learn and level up and get, get points as you're also improving your ability to move.

Farbod: Yeah. One thing that I think you left out is that most of these patients that suffer from a stroke, not only were they given a one, one size fits all approach to their recovery, but because of the extent of damage that can be there to the connection of their nervous system to their muscles, they usually need the assistance of someone else there with them to do these exercises. So, it's not like an independent thing and that person may feel like a burden on others, et cetera, et cetera, or they might be confined to doing their physical rehabilitation in a professional setting. What this unlocks this thing that we're going be talking about is not only a solution that addresses all the concerns that you mentioned, but also a level of independence that I think is missing right now for these patients.

Daniel: No, absolutely. That's a great point. And I think back to Nellie's aunt, right? Nellie's cousin, Alexandra, was like wonderful and went and spent a bunch of time with her mother to take care of her and to help her rehabilitate. But in this case, it would probably have allowed Nellie's aunt the ability to like do things more independently, to focus on rehabilitation on her own, which she already is a super independent person. So, I could definitely see something like this, like being right up her alley, right? Essentially get to play this video game. And as you level up, you're actually leveling up your own physical body, regaining your ability to move your body back, which again, I can only imagine how frustrating that is after a stroke to lose motor control of your body. But definitely an awesome solution here. And again, think that independence is an important part that you pointed out that I neglected to mention in my original explanation.

Farbod: That's why we're here, right? Little yin-yang action.

Daniel: Yes, sir.  

Farbod: In terms of, I guess, their sauce, all of it is really impressive. But the one that stood out to me was probably the digital twin. Do you want to talk about that or did you want to go somewhere else?

Daniel: Well, I kind of want to, before we go into the secret sauce, think we owe them more explanation on what the actual solution is and what it looks like. I think that there are four major ingredients to the solution. You mentioned my favorite one of them, which is the digital twin control loop. But the first three that I want to talk about, one of them is called FES, functional electrical stimulation. It's actually a matrix of electrodes all up and down the arm that apply electrical impulses to stimulate muscle strands in the forearm to initiate hand and or finger movement. think about like a matrix, a web of electrodes stuck all over your arm that can sense movement and then also provide small electric shocks to help move the muscles to initiate the hand finger movement. That's where the issue is and typically after stroke recovery is getting the nervous system to be able to trigger muscle movement. So, it's providing a little bit of extra support, providing a little extra electrical zap, so to speak, to get the muscles to move, to do hand finger movement in the way that the patient is trying to move. Then there's an exoskeleton support, which is kind of like a wearable scaffold that's over the outside of the shoulder and arm. And it kind of supports the entire arm and helps make it almost weightless such that when patient is trying to complete their full arm movement or their hand movements, they're not holding up the weight of their own arm. It can compensate for the fact that not your brain isn't necessarily doing a great job of recruiting all the muscles in your arm. can actually feel quite heavy. Your arm feels quite weak to be able to do something like hold up this microphone that I'm holding up for an extended period of time. So, it helps improve, let's say the endurance with which someone can play this game and use this system to try and train by having full support over their shoulder down to their hand to make sure that their full arm isn't too weak to complete the activities. Final part there that I was interested about, right? There's a computer interface that part of it that they were showing is a video game where you can train your motor skills, adjust different difficulty levels, train specific skills. And that's the part that can be highly personalized to each user's ability. And it goes hand in hand with the digital twin which I think is the secret sauce of all this. And now that I've done the buildup, I'd love to like bump it up or set it up for you to spike, so to speak.

Farbod: Yeah, sure. Thanks. So, the digital twin, as the name implies, you're creating a digital representation of something in the physical world. That thing is the patient themselves, specifically how well their current nervous system to muscle controls work. So, like you were saying earlier, right now you have a patient, the extent of the damage from the stroke is unknown and they're given this one size fits all treatment, which clearly just doesn't work. And what this digital twin allows them to do is to come up with a one-to-one representation of like the experience that the user's having and therefore it adjusts the amount of support given by the structural scaffold of the exoskeleton, the impulses of the FES and honestly the difficulty of the game. So, it becomes this control system in a closed feedback loop that as the patient exercising gets better, it can then adjust itself to make sure that the patient is making continuous progress. And if the patient is struggling, it can bring down the difficulty and provide more assistance so that they can still make progress over their recovery. To me, it kind of feels like you go to the gym and the weight has, whatever machine you're using has different weights that you can pick. Now this control system is kind of like a personal trainer that's there and it already knows what's best for you on your way to become super fit. In this case, being super fit just means getting the control of your muscles back.

Daniel: I'm with you, man. It's pretty awesome. And especially like being able to update itself in real time based off the muscle activity data, the required stimulation levels from the previous activity, how much mechanical support is required, right? It makes this entire solution highly personalized and then also highly geared to help this person improve by helping focus on areas where maybe they were deficient and required extra support during previous activities. And then also realizing the areas where they're already strong and trying to help them to self-drive their recovery without overcompensating. I'm kind of like fusing what a doctor or physical therapist might look at as like the patient's previous performance alongside with their active performance actually during the current activity to kind of understand how much assistance is required. I'm sure that's also a part of like a report card, so to speak, that could be transferred to your doctors and to your physical therapist so they understand how you're doing. Again, I don't think the hope for this is that it completely replaces intervention from your doctors or intervention from your physical therapist, but it actually supplements it and allows folks to be able to independently practice and recover on their own time so that the improvement timeline is a lot faster. And I know that with strokes in particular, there's a, almost like a use it or lose it -esque type of mentality right where the vast majority of the improvement happens in the first couple of weeks after the stroke event. So being able to supplement maybe let's say two or three times a week of physical therapy with additional seven to 10 sessions per week using this type of system might help improve the amount of healing that you see in the first couple of weeks and improve the overall trajectory of the patient's quality of life as they're recovering from the stroke.

Farbod: Totally agree. Another thing I wanted to highlight, minor but to me I think is kind of big, is the gamification of the recovery process. I'm imagining that most folks who suffer a stroke aren't so enthused about going to the physical therapist's office and like you were saying, holding a tennis ball a hundred times a day or something like that. But making a game, even if it's a small game and having a win, a high score, things like that. I'm willing to bet it makes the patients feel a little bit more excited about doing these exercises. So, I guess kind of an appreciation for me to the researchers of doing that.

Daniel: Absolutely. And especially where Doctor actually mentioned it in the video that's attached to the show notes is that it can be relatively discouraging to try and do this practice in the real world. But doing it in a video game with gamification, also with the support that you get from the electron or from the electrode matrix, as well as the exoskeleton makes it possible for patients to do things like playing the game. The game that they demonstrated in the video is like you catch a series of balls that are moving towards you on the screen and then sort them into the correct bucket based off their color. That's something that a patient wouldn't actually be able to do if a physical therapist were to throw tennis balls at them, right? Without this entire system, but they're able to like get this level of stimulation and get this level of practice without feeling majorly discouraged. It actually gamifies it, it encourages them to complete these activities. And in their current trial size of 24 patients, they were able to show that it was modular and portable enough for home use, was able to reduce strain and clinical resources.  And then it was able to massively improve the neuroplastic recovery post-stroke with this highly personalized high-frequency rehabilitation system. They mentioned it's the scalable rehab model, which doesn't require one doctor to look at one patient for several hours, right? It allows several patients to be managed by one doctor and get not round the clock care, but you can basically practice this whenever you want to get help across several motor impairment conditions, not just strokes. Strokes is where they started, but they think that this could help with several different types of motor impairment conditions.

Farbod: It's awesome, man. And all that to say, if my mom is listening, video games are good for you. So that's my main takeaway here. Video games are good. They help people recover. I want more video games in the healthcare industry.

Daniel: Well, I mean, you know, maybe that's not the correct takeaway for you, but the whole point of this podcast is to take cool, interesting technology at the cutting edge, expose it to people. I think this is the first time we've talked about anything related to stroke recovery. And it's awesome that we're able to loop video games into that so you can win a little points with your mom.

Farbod: I agree and I'm glad you agreed to.

Daniel: This is why we're in the same team.

Farbod: Exactly. Exactly. Yeah, I think we're good to wrap it up here.

Daniel: Awesome. Well, a stroke patient, a video game, a robot arm, and a few electric zaps walk into the bar. Sounds like it's going to be a joke, but it's actually the fastest way to recover and move again after a stroke. So, we're talking today about scientists at Technical University of Munich. They made a tool that helps stroke patients move their arms and hands better again. It uses small electric pulses to help wake up the muscles, a robotic arm to help give support. And then that's all connected with a smart computer model that learns what each person needs, changes the help that it gives in real time. And Farbod’s favorite part is that it's a video game. So, it's fun to play, fun to learn, helps improve your body. And then also gives Farbod some negotiating points with his mom to say that doctors say that video games are good for stroke recovery.

Farbod: That is by far my favorite summary of the year.

Daniel: Let's go man.

Farbod: Kudos to you, sir. That's incredible.

Daniel: Thank you.

Farbod: All right. That's the pod.

Daniel: Alrighty. Peace everyone.

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The Next Byte: We're two engineers on a mission to simplify complex science & technology, making it easy to understand. In each episode of our show, we dive into world-changing tech (such as AI, robotics, 3D printing, IoT, & much more), all while keeping it entertaining & engaging along the way.