Robotics for Rehabilitation

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Factors for Success from a European Perspective

Christian Bühler, FTB

There are about 70 million people with disabilities in the EU. Assuming that 1% are potential robot users, and 0.5% of these buy a robot each year, this would lead to a total sales of about 3,500 robots per year. However, there are established alternatives to robotics: environmental control systems, smart homes, dedicated assistive devices, human carers and assistants to do tasks or services that could be provided by rehabilitation robots. Therefore the total number of rehabilitation robots actually in service in the EU currently is estimated at less than 200.

Rehabilitation robotics (RR) is penetrating the market very slowly and is still seen to be a "future technology." A main reason is the availability of alternative solutions. But other factors limit the potential market success. Potential users as well as most rehabilitation advisors do not know the capabilities of robots-or are unaware of the existence of rehabilitation robots.

The decision to purchase a rehabilitation robot is influenced mainly by the expected value of the solution. This can only be estimated roughly by hours of independence gained by its usage, or expressed in perceived utility, or in perceived costs saving. Reimbursing organizations are usually not familiar with this kind of new technology, and therefore they are not convinced of the benefits. The costs are perceived as too high. Furthermore the high service level is problematic for the providers of rehabilitation robots, mostly SMEs (small- to medium-size enterprises) with limited focus on service and support.

The rehabilitation robotics field in Europe, although technically well advanced, suffers from being quite an isolated group of developers and users. They have no infrastructure for presenting their results to a wider audience of potential beneficiaries. R&D projects in RR are seen as particularly critical in terms of outcomes and results. Up to now, only two rehabilitation robots have reached noticeable sales numbers on the market: the Handy1 [4], and the MANUS [5,6].

Therefore, to the public eye, RR is recognized overall as a technology playground for university and academia. The RR community has not been able to correct this distorted picture. Too much technology enthusiasm and too little evidence for usability and benefits have been provided and disseminated so far. Instead of just concentrating on further-certainly needed-technical developments, the RR field would be better supported by a systematic and user-oriented market analysis.

Although some evaluations and studies have been undertaken [7,8,9], we still need to analyze the real benefits and disadvantages of systems in service; we need to better understand who our users are and what they actually need. We need to disseminate cases in which robotic solutions are superior to other solutions and explain why. And we need to define the RR market in terms of technical options, number of pieces, sales and after-sales service structures, business and profits.

The European Dimension of R&D

The R&D in RR received some stimulation through the European research and development programmes [3,10]. Many national activities joined to form consortia with a European rather than national dimension. This is of particular relevance in terms of markets and economy of scale. Other stimulus came from the technology side, where people from the robotics area pushed the RR application. Of course it is a positive development to catch the edge of technology in this application area. On the other hand there might be a danger of loosing credibility of end-users and payers. Some of the technology projects suffer in the eyes of end-users from using expensive machines and technologies, being very much research-oriented, and being unaffordable in real life in the next 5­10 years. Still, we are waiting for mainstream robotics companies or traditional rehabilitation technology industries to foster this application.

The main R&D projects of European consortia in this area (excluding smart wheelchairs and AGV) are listed in the table:

Acronym	Programme	Status	Robot
EPI-RAID	TIDE	finished	RTX
FOCUS	TIDE	ongoing	Manus
Hospimaid	Value	finished	new
Immediate	Sprint	finished	Manus
M3S	TIDE	finished	Manus
MARKUS	TIDE	finished	robotic hand
MOBINET	TMR	ongoing	diverse
MOVEAID	TIDE	ongoing	new
RAID	TIDE	finished	RTX
RAIL	BIOMED	ongoing	Handy1

Of course many national, mostly University-based activities [11], will focus on technical improvements and transfer of mainstream developments. They are often connected to theses work of students.

European RR Initiative

With FERR (Forum for European Rehabilitation Robotics) [12], European players started to intensify discussion of non-technical issues of RR (see earlier issue of RR newsletter). Objectives of FERR have been to promote information exchange and co-operation between existing development teams and users; to provide a forum for a wider cross-section of industrial organizations, rehabilitation specialists and users; to increase public awareness of the availability of this technology; to reduce barriers to wider dissemination; including issues of pricing and reimbursement; and to promote the development of infrastructure for service and support. In 1996 the FERR was transferred into the first special interest group on RR under the umbrella of AAATE (Association for the Advancement of Assistive Technology in Europe). As AAATE is a non-profit organization and only personal membership is possible, the objectives do not focus on commercial issues, but on usability, market issues, education, and R&D. As a platform for fostering information exchange, a homepage [13] of the SIG1 was installed. The AAATE-SIG 1 will sponsor a robotics event at the AAATE 1997 Conference to disseminate information about rehabilitation robotics to people from the AT field.

How to Move On with RR

A starting point for future action in Europe is the list of collaborative actions [12]. However, some of the ideas could be also considered with a more global view:

• rehabilitation robot reference/demonstration centers throughout the EU to measure economic benefits of the robots, to demonstrate applications, and to identify suitable users
• sales and service network for all rehabilitation robots
• seminars on: state-of-the-art presentations, user needs, ergonomic design, user training
• roadshows of all rehabilitation robots
• identifying funding agencies and methods in different states
• simulation system of rehabilitation robots for assessment of potential users by means of virtual reality.
• advocate another notion of "rehabilitation robots" as aids under the full control of the user
• validation of rehabilitation robots
• linking to existing users of rehabilitation
• support of confidence in new technologies through sales and maintenance by local or regional companies or by companies with good and narrow service networks
• joint ventures of large companies ("good name") and SMEs as an approach to build a network for development, sales and service (possibly a big company could be created from several small companies)
• leasing instead selling: a good alternative for a customer to approach this new and widely unknown robot technology with less commitment
• transfer of existing technology
• new customer groups e.g. people with temporary impairments and elderly persons.

Conclusion

It is time to bring the benefits of RR into practice: proven RR needs to come out of the research labs. Technology transfer from the areas of industrial and service robotics needs more attention. We also should move to a progressive strategy to approach the public opinion and convince decision makers by providing evidence of the value of robotic solutions. Only this transition can justify RR research funded by disability grants.

For more information, contact Dr. Christian Bühler, Forschungsinstitut Technologie Behindertenhilfe der Evangelischen Stiftung Volmarstein, Grundschötteler Str. 40, D-58300 Wetter, Germany, Phone: +49 23 35 96 81 10, Fax: +49 23 35 96 81 19, email: sekr@ftb-volmarstein.de, URL: http:// ftb. informatik.uni-essen.de

References

[1] C.A. Stanger, e.a., "Demographics of rehabilitation robotics users", Technology and Disability, Vol 5.No2, September 1996, pp125-137.

[2] Ch. Bühler, "Autonomous robot technology for advanced wheelchair and robotic aids for people with disabilities", Int. J. of Robotics and Autonomous Systems, 14,

[3] E. Ballabio, (editor), "Rehabilitation Technology, Strategies for the European Union, Studies in Health Technology and Informatics, IOS Press Amsterdam, 1993.

[4] M. Topping,"Handy 1, a robotic aid to independence for severely disabled people, Technology and Disability, Vol 5. No2, September 1996, pp 233-235.

[5] Exact Dynamics, "Description of activities", in FERR [8].

[6] G. Verburg, e.a.,"Manus: the evolution of an assistive technology, Technology and Disability, Vol 5.No2, September 1996, pp217-228.

[7] G. Verburg, e.a., "An evaluation of the Manus wheelchair mounted manipulator", Proc. RESNA 92, Toronto, pp. 602-604.

[8] Ch. Bühler, "Approach to the analysis of user requirements in assistive technology", Int. J. of Industrial Ergonomics, Vol. 17, No2, February 1996, Elsevier Science, Amsterdam, pp. 187-192.

[9] J. Hammel, "The role of assessment and evaluation in rehabilitation robotics research and development: Moving from concept to clinic context", IEEE Trans. Rehab. Eng., Vol 3 No 1, 1995, pp. 56-61.

[10] I. Placencia Porrero, editor, "The European Context for Assistive Technology", Assistive technology Research Series, Vol. 1, IOS Press Amsterdam, 1995.

[11] M. Hillman, e.a. (editors) Proc. of ICORR 97, International Conference on Rehabilitation Robotics, Bath (UK), April 1997.

[12] Ch. Bühler, editor, "Forum for European Rehabilitation Robotics", Proceedings of the 1st FERR workshop, Wetter 1995.

[13] AAATE SIG1 homepage: http://hompages. enterprise.net/dallaway/aaate-sig1/

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URL of this document: http://www.asel.udel.edu/ robotics/newsletter/sprsum97/europe.html
Last updated: November 1997
Copyright © Applied Science and Engineering Laboratories, 1997.