Use of Robotics in Physical Therapy

7 November 2008

See how robotics can be used to explore low back pain.
Dr. Greg Kawchuk and his students give Rob Hislop from
CityTV a little ride on their new robot.

News clip compliments CityTV

"SpineBot" puts new spin on spinal research
By Ryan Smith

Dr. Greg Kawchuk knows it is one of the ironies of the modern age that researchers are turning more and more to robotics to understand how the human body works.

"It's true. The fact is, the use of robotics in musco-skeletal research is exploding," says Kawchuk, who would know, seeing as he's among those who have lit the fuse.

A University of Alberta physical therapy professor and the Canada Research Chair in Spinal Function, Kawchuk arrived at the U of A in 2004, drawn from the University of Calgary by an offer to develop his own research program from scratch.

"They asked me, 'What would it take to get you here?' So I wrote out a dream wish list, and robotics was definitely at the top. The U of A supported this vision right from the start, and having this equipment and their support allows me to do some original and innovative research," Kawchuk says.

With funding from the Canada Foundation for Innovation assured, Kawchuk undertook a "robotics tour of North America." "Shopping for a robot really isn't all that different from shopping for a power saw," he says. "You need to know what you want to use it for, and then you look around to see what's out there.

" Kawchuk's quest eventually led him to Parallel Robotic Systems in New Hampshire, where he ordered a custom-built, one-of-a-kind machine he and his colleagues call the "SpineBot." Delivered and set up in a basement laboratory in the U of A Pharmacy and Dentistry building in the spring of 2007, the $400,000 machine looks like a coffee table sitting on six independent struts.

Kawchuk calls it an "ankle wobble-board for the spine." Its computerized set up allows researchers to calibrate and repeat precise, multi-axial movements at specific speeds.

"People don't always move in the same, regular ways, so the Spinebot allows us to manage variables that are normally impossible to control in the usual laboratory environment," says Kawchuk.

One recently completed SpineBot experiment highlighted the utility of lumbar braces for people with back injuries. Test subjects with healthy backs sat on a stool fastened to the SpineBot platform, and then they were gyrated in specific patterns. For safety, they wore helmets and were harnessed to scaffolding that surrounds the SpineBot.

The experiment was repeated with subjects wearing hard or soft lumbar braces. They also "went for a spin" with no brace, at all. Each time, sensors placed on their skin measured their trunk muscles' activity. "People rode the robot in so many different ways, it was amazing. We saw people twisting and torquing in ways we didn't think was possible," says Carolyn Knight, as she contorts her back to mimic those she describes.

Knight laughs, but the U of A physical therapy master's student knows the experiment elicited important results. She and her colleagues found lumbar braces mitigate muscle exertion in the torso, but they don't eliminate it.

"The concern out there is that if you wear a brace your trunk muscles will atrophy and that will set back rehab even more than it would if you didn't wear a brace, but our research suggests that won't happen," says Selena Third, a U of A physical therapy master's student and one of Knight's colleagues on the study.

"Basically, the research implies that the brace won't turn your back into a wet noodle, unless it becomes a permission slip to avoid physical activity," Kawchuk adds. The next step is to conduct the test on subjects with back pain, which is just one of many different tests Kawchuk has planned using the SpineBot. "No one has ever had a robot like this, so, first we need to understand how 'healthy' people respond to it, and then we can branch off into other, original studies that focus on people who have specific disorders," Kawchuk says.

"One of the great things about the SpineBot is that we can go out and record real-world data, such as what it's like to drive a particular bus route down Whyte Avenue, for example, and then recreate that experience on the SpineBot-every little bump and jolt-and measure a person's musco-skeletal response to the ride," he adds.

Armed with such data, therapists can diagnose problems more accurately and offer custom-designed therapies for each patient. Ultimately, Kawchuk hopes to use the SpineBot to develop a set of protocols to help doctors and therapists "measure" the health of a spine. "We can measure your cholesterol or the number of enzymes in your liver, but we don't have the same sort of ability to quantify how the back functions.

Right now we depend on verbal reports of how things are working, and there's nothing wrong with that, but to have an independent measurement of how the spine works would be a huge advantage." Kawchuk believes compiling such data is not unrealistic or even too far off in the future.

"The SpineBot really give us a lot of research options and opportunities," Kawchuk adds. "We're really excited about that and plan to take full advantage of it."