Restoring limb mobility using robotic mechanotherapy. Robots for rehabilitation of disabled people Requirements in the medium term
Rehabilitation of patients after injuries and strokes is a multi-stage process that takes place over a long period of time and includes many components (ergotherapy, kinesiotherapy, massage courses, exercise therapy, classes with a psychologist, speech therapist, treatment with a neurologist).
In modern medicine, new methods are emerging that serve to restore the functioning of the brain and quickly return the patient to normal life.
Robotic mechanotherapy is a new method of rehabilitation
One of the newest trends in restoring a patient’s motor functions is robotic mechanotherapy. Its essence lies in the use of special robotic structures to train the functions of the upper and lower extremities with feedback.
The advantage of robotic therapy is the achievement of the best quality of training compared to traditional physical therapy due to the following factors:
- increasing the duration of classes;
- high accuracy of cyclic, repetitive movements;
- unchangeable uniform training program;
- the presence of mechanisms for assessing the effectiveness of the exercises performed and the ability to show it to the patient.
1. System for rehabilitation of the upper limbs.
This type of device is intended to restore the function of the hands and fingers, mainly in cases of strokes and traumatic brain injuries, and it is also possible to conduct rehabilitation programs for post-traumatic and postoperative pathologies of the joints of the hands, chronic degenerative and inflammatory diseases of the joints of the hands. The essence of the system is the technique of reverse learning of upper limb movements.
When there is an injury or damage to the brain tissue, cells die, and the transmission of impulses in this area of the brain stops. However, thanks to the mechanism of neuroplasticity, the brain can adapt to many pathological situations.
Neuroplasticity is the ability of healthy neurons that are located near the lesion of the brain tissue to connect with surrounding nerve cells and take on certain functions, that is, under certain conditions (for example, receiving stimuli from the periphery) to restore information transmission between the central and peripheral nervous systems.
Therefore, a very important factor is the program of influence of certain stimuli on the affected area of the brain. Such stimuli are repeatedly repeated functional movements that must be performed very precisely in a certain order.
Training on robotic rehabilitation simulators can provide a similar stimulus program. The device can perform three hundred to five hundred high-precision repetitive movements per hour (compared to thirty to forty movements during regular training), which creates optimal conditions for restoring hand function in a shorter period of time.
The course of therapy can be taken in a hospital daily, or on an outpatient basis - then the course is carried out hourly two to three times a week.
2. Robotic complexes for teaching walking skills.
These designs are a breakthrough in robotics and are intended to treat pathological conditions with impaired walking, coordination and balance.
Indications for use are movement disorders of the lower extremities associated with the presence of traumatic brain or spinal injury, the consequences of stroke, parkinsonism, multiple sclerosis and demyelinating diseases.
The entire apparatus may include an automatic gait synchronization platform, a patient body suspension system, automatic system motor activity of the legs and a computer program. By monitoring and regulating the patient's movements using sensors, stimulation of the affected areas of the brain is achieved in a manner similar to what occurs during natural walking. .
The use of such recovery systems allows you to:
- help the patient get back on his feet and restore walking function in the shortest possible time;
- prevent complications associated with immobility of patients for a long time (bedsores, muscle atrophy, congestion in the lungs);
- adapt the patient’s heart and blood vessels to return to physical activity and an upright body position.
The course of therapy can last from fifteen to forty-five workouts. Their number is determined individually for each patient by the attending physician after a clinical examination.
Types of robotic systems
As clinical practice shows, restoring the motor activity of patients with the help of robotic mechanotherapy helps in most cases to avoid disability and return patients to normal life.
You can take a course of robotic mechanotherapy using the latest rehabilitation systems at the Evexia Medical Clinic. These revolutionary recovery methods allow you to program your own personal program for each patient, depending on the needs and capabilities of the patient.
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O.V. CHERCHENKO,
Researcher, Federal State Budgetary Institution "Directorate of Scientific and Technical Progress", Moscow, Russia, [email protected]
S.A. SHEPTUNOV,
Doctor of Technical Sciences, Director of IKTI RAS, Moscow, Russia, [email protected]
ROBOT-ASSISTED SURGERY AND ROBOT-EXOSKELETONS FOR REHABILITATION OF PEOPLE WITH MUSCULOSKETAL DISORDERS: WORLD TECHNOLOGICAL LEADERS AND PROSPECTS FOR RUSSIA
Cherchenko O.V., Sheptunov S.A. Robot-assisted surgery and robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders: world technological leaders and prospects for Russia (Federal State Budgetary Institution “Directorate of Scientific and Technical Progress”, Moscow, Russia; IKTI RAS, Moscow, Russia)
Annotation. The results of an analysis of publication and patent activity in the two most actively developing areas of the medical robotics industry are presented: robotic exoskeletons for the rehabilitation of people with impaired musculoskeletal functions, robot-assisted surgery. A discrepancy in the structure of global and national publication and patent flows has been revealed. The shortcomings of foreign developments in robot-assisted surgery are noted, which create the prerequisites for the promotion of import-substituting developments of domestic engineers.
Key words: robot-assisted surgery, exoskeletons for the rehabilitation of people with musculoskeletal disorders, technological leaders, competitiveness, scientometric analysis, patent analysis.
© O.V. Cherchenko,
S.A. Sheptunov, 2015
Medical robots can be defined as electronic-mechanical devices that partially or completely perform the functions of a person or his individual organs and systems in solving various medical problems. Back in 1998, Joseph Endelberger, an American engineer and entrepreneur who created the world’s first private company for the production of programmable machines and received the title “father of robotics” for this, introducing the HelpMate Trackless Robotic Courier robot assistant, said that hospitals This is the very environment that is ideal for the use of robots.
Robots are likely to create new added value in healthcare by:
1. reducing labor costs by performing certain operations not by humans, but by robotic means;
2. social and economic benefits by increasing the independence and social activity of people in need of specialized care;
3. increasing the quality of care provided by robotic systems (robots can perform more subtle manipulations and perform repetitive actions with a greater degree of accuracy than humans);
4. performing operations that a person cannot perform, including surgery, due to size limitations or non-
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Market growth rate
Rice. 1. Global market forecast for robotic surgical systems (excluding radiosurgery systems) (Source: Wintergreen Research, BCC Research, Global Data)
the need for increased accuracy of operations performed.
Medical devices account for the bulk of the professional service robot market in value terms. This segment includes robotic surgical systems, radiation therapy devices and devices for patient rehabilitation. According to RVC's analytical review, sales volume similar devices amounted to 1.45 billion US dollars, or 41% of the value of all professional robots sold in 2013, excluding military systems.
In various forecasts, the volume of the global market for medical robotic systems by 2018 is estimated in the range from $13.6 billion to $18 billion, and by 2020 it is likely to reach more than $20 billion with an annual growth rate of 12-12 billion. 12.6%.
Surgical robots are expected to make up the largest share of revenue.
According to the combined forecast of Winter-green Research, BCC Research, Global Data, the estimated market size of robotic surgical systems (excluding components and Supplies,
excluding radiosurgery) by 2025 will amount to 6.6 billion US dollars (Fig. 1).
A separate sector in the overall medical equipment market will be the exoskeleton market, which is expected to grow even more. According to the study “Rehabilitation robots: the stock market,
strategies and forecasts worldwide from 2015 to 2021" from Wintergreen Research, published in Research and Markets, the market size of medical rehabilitation robots and mechanisms in 2014 was $203.3 million and is projected to reach a profit of $1 by 2021 .1 billion.
The purpose of this study was to determine, based on data from multi-criteria scientometric and patent analyses, the main trends in the scientific and technological development of medical robotics in the world, as well as to assess the competitiveness of scientific and technological advances and Russia’s position in this technological market using the example of the two most actively developing areas of the industry:
Robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders;
Robot-assisted surgery.
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Rice. 2. Dynamics of publication activity in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders”
(according to Web of Science Core Collection as of March 25, 2015)
An analysis of the current level and trends in the development of research activity in selected areas in the world and in Russia was carried out using one of the most authoritative sources of analytical information about key scientific research in the world - the international citation index Web of Science Core Collection.
To determine the industrialization potential of the areas under study and the competitiveness of Russian technological advances, this study used the author’s methodology of multi-criteria patent analysis of the working group led by N.G. Kurakova, which includes an assessment of the dynamics of patent activity in the world by direction, an assessment of the distribution of patent documents by their status, an assessment of the share of applications for inventions compared to the share of issued patents and other indicators. Patent analysis was conducted using Orbit and Thomson Innovation patent databases.
Scientometric and patent analyzes were performed for the period from 1995 to 2015.
Technologies for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders
An exoskeleton is an external frame that makes it easier for a person to perform musculoskeletal functions. In medicine, this is the name for devices that could be used by people with limited mobility to provide movement through support, as well as for regular training aimed at restoring lost mobility.
According to the international index Web of Science Core Collection, the volume of publications in this scientific area is growing exponentially (Fig. 2).
The leading countries in the world by the number of articles are the USA, China, and Italy. Russia accounts for only 0.1% of the global publication flow.
There is an exponential growth in patent activity in the area under study in the world. This is evidenced by our analysis, performed using two patent databases: Orbit (Fig. 3) and Thomson Innovation (Fig. 4).
Noteworthy is the increase in the number of applications for inventions, the number of which exceeds the number of valid patents, which is a sign of great potential for the development of a technological area (Fig. 5).
The drivers of the direction are the USA, China and the Republic of Korea - it is between these countries that the struggle for future niche markets created by devices of such functional purposes will most likely unfold. Data from the Orbit database (Fig. 6) and Thomson Innovation (Fig. 7) visualize the technological leadership of these three countries in the projection of patent analysis.
Russia is in 11th place in the number of patents received by residents of the country, but the share of national patents is only 1% of the global total in this area (Fig. 6).
Analysis of the distribution of patents by year made it possible to record the change in the world technological leader. As follows from the data,
ECONOMICS OF SCIENCE 5015, Vol. 1, No. 2
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Publication years
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-->---CNCN(N Rice. 3. Dynamics of patent activity in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015) Rice. 4. Dynamics of patent activity in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Thomson Innovation as of April 13, 2015) Rice. 5. Distribution of patent documents by legal status in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015) ECONOMICS OF SCIENCE 201 5, Vol. 1, No. 2 mainstream Priority countries Rice. 6. Distribution of patents in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” by priority countries (according to Orbit data as of March 25, 2015) Rice. 7. Distribution of patents in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” by priority countries (according to Thomson Innovation as of April 13, 2015) presented in Fig. 8, in the development of technologies for creating an exoskeleton robot, since 1996, developers from many countries have taken part, making commensurate contributions to its industrialization. However, according to Thomson Innovation, in 2012 China comes out on top in terms of the total number of patents received by residents of the country. The patenting activity of Korean technologies has also been growing rapidly since 2005 (Fig. 8). Patent analysis data obtained using the Orbit database allows us to note the same pattern in the change of technological leader: until 2006, several industrial companies took part in the development of technologies for creating an exoskeleton robot developed countries, the research and inventive activity of the United States especially stands out. However, since 2006, China begins to increase its activity in patenting national technical solutions and becomes the obvious world technological leader by 2012. The Republic of Korea has also demonstrated an increase in patent activity since 2007. Unfortunately, the scientific and technological groundwork of Russia during 2007-2013. are not reflected or protected by any significant number of patents (Fig. 9). Among Russian patents on technologies for creating an exoskeleton robot, 65% were issued to residents of the country, more than a third of Russian patents were received by non-residents (Fig. 10). ECONOMICS OF SCIENCE 5015, Vol. 1, No. 2 mainstream Rice. 8. Dynamics of patent activity in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” in different countries by priority (according to Thomson Innovation as of April 13, 2015) Rice. 9. Dynamics of patent activity in the area of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” in different countries by priority (according to Orbit data as of March 25, 2015) Rice. 10. Dynamics of patent activity of residents of the Russian Federation in the direction of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015) ECONOMICS OF SCIENCE 201 5, Vol. 1, No. 2 mainstream Table 1 Top 10 patent holders in the world in the field of “technologies for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders” Patent holders Number of patents ZHEJIANG UNIVERSITY 40 SHANGHAI JIAO TONG UNIVERSITY 25 UNIVERSITY OF ELECTRONIC SCIENCE & TECHNOLOGY OF CHINA 18 HARBIN INSTITUTE OF TECHNOLOGY 17 UNIVERSITY OF CALIFORNIA 14 SOGANG UNIVERSITY INDUSTRY-UNIVERSITY COOPERATION FOUNDATION 12 SOUTHWEST JIAOTONG UNIVERSITY 11 BEIJING UNIVERSITY OF TECHNOLOGY 10 UNIVERSITY OF SHANGHAI FOR SCIENCE & TECHNOLOGY 9 Source: according to the Orbit database as of March 25, 2015. In table 1 presents the top 10 patent holders in the world with the largest portfolios of patents in the field. Most of the patents with Russian priority belong to Moscow State University named after M.V. Lomonosov (45%). Technologies of robot-assisted surgery Robot-assisted surgery is the latest achievement in laparoscopic technology and minimally invasive surgery, implying minimal surgical trauma and reduced pain for the patient. There are a number of advantages of robot-assisted surgery that suggest that widespread adoption of the technology would take surgery as a whole to a new level: A fundamental change in the work of a surgeon with the provision of a wide range of opportunities; Improved 3D visualization of anatomical structures, especially neurovascular bundles; Ensuring that young specialists perform high-quality operations after completing a specialized training course; Performing high-quality operations in those anatomical areas where it was previously impossible to perform minimally invasive interventions; Absence of tremor, careful and “gentle” tissue excision; Minimal traction and displacement of neighboring organs. Publication activity in the field of robot-assisted surgery, according to the Web of Science Core Collection, has been growing steadily over the past twenty years (Fig. 11). The publication leaders are the USA, Germany and Japan, the share of Russian publications is 0.1% of the global flow (41st place in the world). The activity of patenting technological solutions in the area under study is also growing exponentially, according to the Orbit database (Fig. 12) and the Thomson Innovation database (Fig. 13). The number of patents issued annually since 2009 is two hundred. ECONOMICS OF SCIENCE 5015, Vol. 1, No. 2 mainstream 400 -350 -300 -250 -200 - "ONCOO^O"-CNn"fin"ONCOO"O^Wn^iO O"OO-OOOOOOOOOOOO-- O"O"OCNOOOOOOOOOOOOOOOO CNCNCNCNCNCNCNCMCNCNCNCNCNCNCNCN Rice. 11. Dynamics of publication activity in the area of “technology of robot-assisted surgery” (according to Web of Science Core Collection as of March 24, 2015) nami, and the number of patent applications filed is growing exponentially (Fig. 14). The technology leaders in this area include the USA, the Republic of Korea, and China - this is evidenced by the Orbit database data (Fig. 15) and patent analysis data performed using the Thomson Innovation database (Fig. 16). The United States is listed as the priority country in half of the patent documents issued in this area. The share of patents received by Russian residents is only 1.91% of the global number of patent documents. With this indicator, the Russian Federation ranks 8th, but in this indicator it lags behind China, which occupies third position in the ranking of the patent portfolio, by 6.7 times (Fig. 15). Rice. 12. Dynamics of patent activity in the area of “robotic-assisted surgery technology” (according to Orbit data as of March 24, 2015) Rice. 13. Dynamics of patent activity in the area of “robotic surgery technology” (according to Thomson Innovation as of April 13, 2015) ECONOMICS OF SCIENCE 201 5, Vol. 1, No. 2 mainstream ■ Inactive ■ Applications ■ Active US WO KR CN DE EP JP RU GB FR CA IT ES AU UA Priority countries Fig. 14. Distribution of patent documents by legal status in the area of “robot-assisted surgery technology” (according to Orbit data as of March 24, 2015) Rice. 15. Distribution of patents in the area of “robotic-assisted surgery technology” by priority country (according to Orbit data as of March 24, 2015) Rice. 16. Distribution of patents in the area of “robotic-assisted surgery technology” by priority country (according to Thomson Innovation as of April 13, 2015) ECONOMICS OF SCIENCE 5015, Vol. 1, No. 2 mainstream Rice. 17. Dynamics of patent activity in the area of “robot-assisted surgery technology” in different countries by priority (according to Thomson Innovation as of April 13, 2015) Rice. 18. Dynamics of patent activity in the area of “robot-assisted surgery technology” in different countries by priority (according to Orbit data as of March 24, 2015) RU WO US EP CA IT ES KR DE FR Priority countries Rice. 19. Dynamics of patent activity of residents of the Russian Federation in the area of “robotic-assisted surgery technology” (according to Orbit data as of March 24, 2015) ECONOMICS OF SCIENCE 201 5, Vol. 1, No. 2 mainstream table 2 Top 10 patent holders in the world in the field of robot-assisted surgery technology Quantity patents INTUITIVE SURGICAL 246 ETHICON ENDO SURGERY 45 SAMSUNG ELECTRONICS 39 HANSEN MEDICAL 39 JOHNS HOPKINS UNIVERSITY 30 DEUTSCH ZENTR LUFT & RAUMFAHRT 25 TIANJIN UNIVERSITY 24 OPERATIONS INTUITIVE SURGICAL 23 Source: (according to Orbit data as of February 24, 2015) According to the Thomson Innovation database, the United States has maintained leadership as a priority country from 1995 to the present. In the Republic of Korea, the first patents were received by residents in 2006, and by residents of China in 2003, but today both countries are actively involved in the struggle for the markets for robot-assisted surgery devices (Fig. 17). The Orbit database visualizes the same trend. US researchers have demonstrated consistently high patent activity in this area over the entire twenty-year observation period, and since 2006, China and the Republic of Korea have entered the competition for leadership. Russia, unfortunately, is the country of priority for single patents in the period from 2002 to 2013. (Fig. 18). In total, 64 Russian patents have been issued for solutions in the field of robot-assisted surgery technologies, of which 40 belong to Russian applicants. The distribution of Russian patents by priority country (Fig. 19) shows that non-residents account for 37.5% of patents issued in the Russian Federation, most of which were issued to US companies. In table 2 presents the top 10 patent holders in the world in the field of robot-assisted surgery. The absolute leader among them is Intuitive Surgical (USA), which became the developer of the system "Da Vinci" The company's patent portfolio greatly complicated the development of the robot-assisted surgery market, since it covered the fundamental design solutions and elements of the surgical robot. But, as can be seen from the examples of China and the Republic of Korea, new technological solutions can still be found in conditions of actively developing technology with an obvious monopolist. Ethicon Endo Surgery, which occupies third position in the ranking, has received 4 Russian patents. Russian patent holders in the area of “robotic-assisted surgery technologies” are represented by companies and universities that each have 1-2 patents. Conclusion The presented data does not allow us to characterize the scientific and technological progress of the Russian Federation in the field of robotic exoskeletons for the rehabilitation of people with impaired musculoskeletal functions and robot-assisted surgery as competitive. Unfortunately, it was not possible to find patents of domestic technology companies, indicating the latter’s readiness to offer serial products not only to the global, but also to the domestic market. ECONOMICS OF SCIENCE 5015, Vol. 1, No. 2 mainstream Meanwhile, the growth rate of the global markets for robotic surgeons and robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders allows us to characterize them as new and dynamically growing. Therefore, Russian developers have every chance to occupy niche markets. The need for new Russian developments in robotic surgery is also due to a number of shortcomings in the Da Vinci system used in the world: The surgeon lacks tactile sensations; Large weight and size of the system; Long period of preparation for surgery; Lack of tracking system to the target (pathology site); Small viewing angle (lack of peripheral vision) for the operator of the surgeon's console; Using one mechanism to perform different movements; Long-term installation of trocars compared to standard laparoscopic operations; Lack of contact with the patient; Lack of 3D vision for a doctor assisting directly next to the patient. In addition to the above-mentioned areas of technological development of these systems, special mention should be made of the cost characteristics of the Da Vinci system and individual instruments and accessories (the average cost of one complex is 3 million euros). Training of personnel to work with the system is possible only abroad. A big problem is technical support and maintenance of the system in Russia. All the noted shortcomings create excellent prerequisites for the promotion of import-substituting developments of domestic engineers, which means that the inclusion of technologies for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions and robot-assisted surgery among the priorities of scientific and technological development of Russia is fully justified. LITERATURE 1. Kraevsky S.V., Rogatkin D.A. Medical robotics: the first steps of medical robots // Technologies of living systems. 2010. - T. 7. - No. 4. - P. 3-14. 2. Expert-analytical report “The potential of Russian innovations in the market of automation systems and robotics.” 2014. The report was prepared by Larza LLC at the request of RVC OJSC. Http://www.rusventure.ru/ru/programm/analy-tics/docs/Otchet_robot-FINAL%>20291014.pdf. 3. Transparency Market Research. Medical Robotic Systems Market (Surgical Robots, Non-Invasive Radiosurgery Robotic Systems, Prosthetics and Exoskeletons, Assistive and Rehabilitation Robots, Non-Medical Robotics in Hospitals and Emergency Response Robotic Systems) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2012-2018. - http:// www.transparencymarketresearch.com/medical-robotic-systems.html. 4. Could Titan Medical Storm The Robotic Surgery Market? March 27th, 2014 by Alpha Deal Group LLC. - http://alphanow.thomsonreuters.com/ 2014/03/titan-storm-robotic-surgery-market/# 5. Market of rehabilitation robots until 2021 - http://robolovers.ru/robots/post/783338/ry-nok_reabilitatsionnyh_robotov_do_2021_goda/ 6. Kurakova N.G., Zinov V.G., Tsvetkova L.A., Erem-chenko O.A., Komarova A.V., Komarov V.M., Sorokina A.V., Pavlov P.N. , Kotsyubinsky V.A. The "rapid response" science model in Russian Federation: methodology and organization. - M.: Publishing house "Delo" RANEPA, 2014. - 160 p. 1. Kraevskij S.V., Rogatkin D.A. Medical robototronics: first steps of medical robots // Technologies of live systems. - 2010. - Is. 7. - No. 4. - P. 3-14. 2. Expert-analytical report “Potential of Russian innovations on the market of automation and ECONOMICS OF SCIENCE 201 5, T. 1, No. 2_______ robototronics" (2014) Report is prepared by LLC "Larza" on behalf of JSC "RVK". http://www.rus-venture.ru/ru/programm/analytics/docs/Otchet_ robot-FINAL%20291014.pdf. mainstream 3. Transparency Market Research. Medical Robotic Systems Market (Surgical Robots, Non-Invasive Radiosurgery Robotic Systems, Prosthetics and Exoskeletons, Assistive and Rehabilitation Robots, Non-Medical Robotics in Hospitals and Emergency Response Robotic Systems) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2012-2018. - http://www.transparencymarketrese-arch.com/medical-robotic-systems.html. 4. Could Titan Medical Storm The Robotic Surgery Market? (2014) Alpha Deal Group LLC. http:// alphanow.thomsonreuters.com/2014/03/ti- tan-storm-robotic-surgery-market/#. 5. Market of rehabilitation robots until 2021 year (2015). http://robolovers.ru/robots/post/783338/rynok_reabilitatsionnyh_robotov_do_2021_goda/. 6. Kurakova N.G., Zinov V.G., Tsvetkova L.A., Ye-remchenko O.A., Komarova A.V., Komarov V.M., Sorokina A.V., Pavlov P.N., Kotsubinskiy V.A. (2014) Model of a “direct action” science in the Russian Federation: methodology and organization // Publishing House “Delo” RANEPA. - 160 p. Cherchenko O.V., Sheptunov S.A. Robot-assisted surgery and robots exoskeletons for rehabilitation: world technological leaders and perspectives of Russia (Directorate of State Scientific and Technical Programs, Moscow, Russia; Institute for Design-Technological Informatics Russian Academy of Sciences, Moscow, Russia) Abstract. There was analyzed the publication and patent activity with regard to two actively developing areas in the field of medical robototronics: robots-exoskeletons for rehabilitation of people with musculoskeletal disorders and robot-assisted surgery. There was identified discrepancy in the structure of global and national publication and patent flows. There were revealed disadvantages of foreign innovations on robot-assisted surgery, which create prerequisites for promoting import-substituting innovations of domestic engineers. Keywords: robot-assisted surgery, robots-exoskeletons for rehabilitation of people with musculoskeletal disorders, technology leaders, competitive ability, scientometric analysis, patent analysis. RAS RESEARCH PLANS NOW APPROVED BY FANO Decree of the Government of the Russian Federation dated May 29, 2015 No. 522 “On some issues of the activities of the Federal Agency for Scientific Organizations and the Federal State budgetary institution «« Russian Academy Sciences" In accordance with the new rules for coordinating the activities of FANO and the RAS, the latter must coordinate with FANO the research plans developed by scientific organizations within the framework of the Fundamental Science Program scientific research state academies of sciences for 2013-2020. FANO approves, in agreement with the RAS, programs for the development of scientific organizations, as well as state assignments for conducting fundamental and exploratory scientific research of organizations subordinate to the agency. If irresolvable disagreements arise between the agency and the RAS, work to overcome them is transferred to the Deputy Chairman of the Government, who coordinates the work of federal executive bodies on issues public policy in the field of science. 130 _____________________________________ ECONOMICS OF SCIENCE 2015, Vol. 1, No. 2 Equipment such as rehabilitation and physiotherapy equipment is used in medicinal purposes for the recovery of patients after operations and injuries, as well as for the prevention functional disorders body. LLC M.P.A. medical partners" offers high-tech rehabilitation and physiotherapeutic equipment from world famous brands. We also design specialized rooms in hospitals, clinics, sanatoriums, sports centers, fitness clubs and provide after-sales service for exercise equipment. The second half of the twentieth century was a time of intensive development in all areas of science, technology, electronics and robotics. Medicine has become one of the main vectors for the introduction of robots and artificial intelligence. The main goal of the development of medical robotics is high accuracy and quality of service, increasing the effectiveness of treatment, and reducing the risks of harm to human health. Therefore, in this article we will look at new treatment methods, as well as the use of robots and automated systems in various fields of medicine. Back in the mid-70s, the first medical mobile robot ASM appeared in a hospital in Fairfax, Virginia, USA, which transported containers with trays for feeding patients. In 1985, the world first saw the PUMA 650 robotic surgical system, designed specifically for neurosurgery. A little later, surgeons received a new PROBOT manipulator, and in 1992 the RoboDoc system appeared, which was used in orthopedics for joint replacement. A year later, Computer Motion Inc. introduced the Aesop automatic arm for holding and repositioning a video camera during laparoscopic operations. And in 1998, the same manufacturer created a more advanced ZEUS system. Both of these systems were not completely autonomous; their task was to assist doctors during operations. In the late 90s, the developer company Intuitive Surgical Inc created a universal remote-controlled robotic surgical system - Da Vinci, which is being improved every year and is still being implemented in many medical centers around the world. Classification of medical robots:
Currently, robots play a huge role in the development of modern medicine. They contribute to accurate work during operations, help to diagnose and make the correct diagnosis. They replace missing limbs and organs, restore and improve a person’s physical capabilities, reduce hospitalization time, provide convenience, responsiveness and comfort, and save financial costs of care. There are several types of medical robots, differing in their functionality and design, as well as their scope of application for various fields of medicine: Robotic surgeons and robotic surgical systems- used for complex surgical operations. They are not stand-alone devices, but a remotely controlled instrument that provides the doctor with accuracy, increased dexterity and controllability, additional mechanical strength, reduces the surgeon’s fatigue, and reduces the risk of the surgical team contracting hepatitis, HIV and other diseases. Patient simulator robots- designed to develop decision-making skills and practical medical interventions in the treatment of pathologies. Such devices fully reproduce human physiology, simulate clinical scenarios, respond to drug administration, analyze the actions of trainees and respond accordingly to clinical influences. Exoskeletons and robotic prostheses- exoskeletons help increase physical strength and help with the recovery process of the musculoskeletal system. Robotic prostheses - implants that replace missing limbs, consist of mechanical-electrical elements, microcontrollers with artificial intelligence, and are also capable of being controlled by human nerve endings. Robots for medical institutions and robotic assistants- are an alternative to orderlies, nurses, caregivers, nannies and other medical personnel, capable of providing care and attention to the patient, assisting in rehabilitation, ensuring constant communication with the attending physician, and transporting the patient. Nanorobots- microrobots operating in the human body at the molecular level. They are developed for diagnosing and treating cancer, conducting research on blood vessels and restoring damaged cells; they can analyze the structure of DNA, correct it, destroy bacteria and viruses, etc. Other specialized medical robots- There are a huge number of robots that help in one or another process of human treatment. For example, devices that are capable of automatically moving, disinfecting and quartzing hospital premises, measuring pulses, taking blood for analysis, producing and dispensing medications, etc. Let's take a closer look at each type of robot using examples of modern automated devices developed and implemented in many areas of medicine. Robotic surgeons and robotic surgical systems:
The most famous robotic surgeon in the whole world is the Da Vinci device. The device, manufactured by Intuitive Surgical, weighs half a ton and consists of two blocks, one is a control unit designed for the operator, and the second is a four-armed machine that acts as a surgeon. The manipulator with artificial wrists has seven degrees of freedom, similar to the human hand, and a 3D visualization system that displays a three-dimensional image on a monitor. This design increases the accuracy of the surgeon’s movements, eliminates hand tremors and awkward movements, reduces the length of incisions and blood loss during surgery. Robot surgeon Da Vinci Using the robot, it is possible to perform a huge number of different operations, such as mitral valve repair, myocardial revascularization, ablation of cardiac tissue, installation of an epicardial electronic cardiac stimulator for biventricular resynchronization, thyroid surgery, gastric bypass, Nissen fundoplication, hysterectomy and myomectomy, operations on spine, disc replacement, thymectomy - surgery to remove the thymus gland, lung lobectomy, operations in urology, esophagectomy, mediastinal tumor resection, radical prostatectomy, pyeloplasty, bladder removal, tubal ligation and ligation, radical nephrectomy and kidney resection, ureteral reimplantation and other. Currently, there is a struggle for the market for medical robots and automated surgical systems. Scientists and medical device companies are eager to implement their devices, which is why more and more robotic devices are appearing every year. Competitors to Da Vinci include the new MiroSurge surgical robot designed for heart surgery, a robotic arm from UPM for precise insertion of needles, catheters and other surgical instruments in minimally invasive surgery procedures, a surgical platform called IGAR from CSII, a robotic system -Sensei X catheter, manufactured by Hansen Medical Inc for complex heart surgeries, ARTAS hair transplant system from Restoration Robotics, Mazor Renaissance surgical system, which helps perform surgeries on the spine and brain, robot surgeon from scientists from SSSA Biorobotics Institute, and a robotic assistant for tracking surgical instruments from GE Global Research, currently in development, and many others. Robotic surgical systems serve as assistants or assistants to physicians and are not completely autonomous devices. Robot surgeon MiroSurge Robot surgeon IGAR Robot catheter Sensei X Robotic hair transplant system ARTAS Robot surgeon Mazor Renaissance Robot surgeon from SSSA Biorobotics Institute Surgical Instrument Tracking Robot from GE Global Research Patient simulator robots:
To develop the practical skills of future doctors, there are special robotic mannequins that reproduce the functional features of the cardiovascular, respiratory, and excretory systems, and also involuntarily react to various actions of students, for example, when administering pharmacological drugs. The most popular robotic patient simulator is HPS (Human Patient Simulator) from the American company METI. You can connect a bedside monitor to it and track blood pressure, cardiac output, ECG and body temperature. The device is capable of consuming oxygen and releasing carbon dioxide, just like real breathing. During anesthesia, nitrous oxide may be absorbed or released. This function provides training in artificial lung ventilation skills. The pupils in the robot's eyes are able to react to light, and the movable eyelids close or open depending on whether the patient is conscious. The pulse is felt in the carotid, brachial, femoral, and radial popliteal arteries, which changes automatically and depends on blood pressure. The HPS simulator has 30 patient profiles with different physiological data, simulating a healthy husband, a pregnant woman, an elderly person, etc. During the training process, a specific clinical scenario is simulated, which describes the scene and condition of the patient, goals, necessary equipment and medicines. The robot has a pharmacological library consisting of 50 drugs, including gaseous anesthetics and intravenous drugs. The mannequin is controlled via a wireless computer, allowing the instructor to monitor all aspects of the learning process directly next to the student. It should be noted that maternity simulator mannequins, for example GD/F55, are very popular. It is designed for training medical personnel in obstetrics and gynecology departments, allowing you to develop practical skills and abilities in gynecology, obstetrics, neontology, pediatrics, intensive care and nursing care in the maternity ward. The Simroid robot imitates a patient in a dentist's chair; its oral cavity exactly replicates a human's. The device is capable of simulating the sounds and groans that a person makes if he is in pain. There are robotic simulators for teaching manipulation techniques. This is, in fact, a dummy of a person with simulators of veins and vessels made of elastic tubes. On such a device, students practice the skills of venesection, catheterization, and venipuncture. Exoskeletons and robotic prostheses:
One of the most famous medical devices is the robotic suit - the exoskeleton. It helps people with physical disabilities move their bodies. At the moment when a person tries to move his arms or legs, special sensors on the skin read small changes in the electrical signals of the body, bringing the mechanical elements of the exoskeleton into working order. Some of the popular devices are the Walking Assist Device from the Japanese company Honda, the HAL rehabilitation exoskeleton from the Cyberdyne company, widely used in Japanese hospitals, the Parker Hannifin apparatus from Vanderbilt University, which makes it possible to move the joints of the hips and knees, powerful NASA X1 exoskeleton, designed for astronauts and paralyzed people, Kickstart exoskeleton from Cadence Biomedical, powered not by a battery, but using the kinetic energy generated by a person when walking, eLEGS, Esko Rex, HULC exoskeletons from the manufacturer Ekso Bionics, ReWalk from ARGO, Mindwalker from Space Applications Services, helping paralyzed people, as well as a unique brain-machine interface (BMI) or simply an exoskeleton for the brain MAHI-EXO II for restoring motor functions by reading brain waves. The widespread use of exoskeletons helps many people around the world feel full. Even completely paralyzed people today have the ability to walk. A striking example The robotic legs of physicist Amit Goffer are used, which are controlled using special crutches and can automatically determine when to take a step and recognize speech signals “forward”, “sit”, “stand”. Exoskeleton for walking Walking Assist Exoskeleton HAL from Cyberdyne Parker Hannifin exoskeleton Exoskeleton NASA X1 Kickstart exoskeleton from Cadence Biomedical Exoskeleton HULC from Ekso Bionics ARGO ReWalk exoskeleton Mindwalker exoskeleton from Space Applications Services Exoskeleton for the brain MAHI-EXO II Exoskeleton by Amit Goffer But what to do when limbs are missing? This applies mainly to war veterans, as well as victims of accidental circumstances. In this regard, companies such as Quantum International Corp (QUAN) and their exoprosthetics and the Defense Advanced Research Projects Agency (DARPA), together with the Department of Veterans Affairs, the Center for Rehabilitation and the US Development Service, are investing huge amounts of money in the research and development of robotic prosthetics (bionic arms or legs) that have artificial intelligence, capable of feeling environment and recognize user intent. These devices accurately imitate the behavior of natural limbs, and are also controlled using one's own brain (microelectrodes implanted in the brain, or sensors, read neural signals and transmit them as electrical signals to a microcontroller). The owner of the most popular bionic arm, costing $15,000, is Briton Nigel Ackland, who travels around the world promoting the use of artificial robotic prostheses. One of the important scientific developments was the iWalk BiOM artificial robotic ankles, developed by MIT professor Hugh Herr and his biomechatronics group at the MIT Media Lab. iWalk receives funding from the US Department of Veterans Affairs and the Department of Defense, and as such, many disabled veterans who served in Iraq and Afghanistan have already received their bionic ankles. iWalk BiOM robotic ankles Scientists from all over the world are striving not only to improve the functional features of robotic prostheses, but to give them a realistic appearance. American researchers led by Zhenan Bao from Stanford University in California have created nanoskin for medical prosthetic devices. This polymer material has high flexibility, strength, electrical conductivity and pressure sensitivity (reading signals like touch panels). Nanoskin from Stanford University Robots for medical institutions and robotic assistants:
The hospital of the future is a hospital with minimal human staff. Every day, robotic nurses, robotic nurses and telepresence robots are increasingly being introduced into medical institutions to contact the attending physician. For example, robotic nurses from Panasonic, robot assistants Human Support Robot (HSR) from Toyota, the Irish robot nurse RP7 from the developer InTouch Health, the Korean robot KIRO-M5 and many others have been working in Japan for a long time. Such devices are a platform on wheels and are capable of measuring pulse, temperature, monitoring the time of food and medication intake, promptly notifying about problematic situations and necessary actions, maintaining contact with live medical personnel, collecting scattered or fallen things, etc. Robotic nurses from Panasonic Toyota HSR robot assistant Robot nurse RP7 from InTouch Health Robot nurse KIRO-M5 Often, in conditions of continuous medical care, doctors are physically unable to pay enough attention to patients, especially if they are located at a great distance from each other. Developers of robotic medical equipment have tried and created telepresence robots (for example, LifeBot 5, or RP-VITA from iRobot and InTouch Health). Automated systems allow you to transmit audio and video signals through 4G, 3G, LTE, WiMAX, Wi-Fi, satellite or radio networks, measure the patient’s heartbeat, blood pressure and body temperature. Some devices can perform electrocardiography and ultrasound, have an electronic stethoscope and otoscope, and navigate hospital corridors and wards around obstacles. These medical assistants provide timely care and process clinical data in real time. Telepresence robot LifeBot 5 Telepresence robot RP-VITA Robotic couriers have been used with great success to safely transport samples, medications, equipment and supplies in hospitals, laboratories and pharmacies. The assistants have a modern navigation system and on-board sensors, allowing them to easily navigate rooms with complex layouts. Prominent representatives of such devices include the American RoboCouriers from the company Adept Technology and Aethon from the University of Maryland Medical Center, the Japanese Hospi-R from Panasonic and Terapio from the company Adtex. Robot courier RoboCouriers from Adept Technology Robot courier Aethon Robot courier Hospi-R from Panasonic Robot courier Terapio from Adtex
Nanorobots:
Nanobots or nanobots are robots the size of a molecule (less than 10 nm) that are capable of moving, reading and processing information, as well as being programmed and performing specific tasks. This is a completely new direction in the development of robotics. Areas of use of such devices: early diagnosis of cancer and targeted delivery of drugs to cancer cells, biomedical instruments, surgery, pharmacokinetics, monitoring of diabetic patients, production of devices from individual molecules according to its drawings through molecular assembly by nanorobots, military use as means of surveillance and espionage, and also as weapons, space research and development, etc. At the moment, the development of medical microscopic robots for detecting and treating cancer from South Korean scientists is known, biorobots from scientists from the University of Illinois that can move in viscous liquids and biological environments on their own, a prototype of the sea lamprey - nanorobot Cyberplasm, which will move in the human body, detecting diseases at an early stage, engineer Ado Pun's nanorobots, which can travel across circulatory system, deliver medicines, take tests and remove blood clots, magnetic nanorobot Spermbot - developed by scientist Oliver Schmidt and his colleagues from the Institute of Integrative Nanosciences in Dresden (Germany) for the delivery of sperm and medicines, nanobots for replacing proteins in the body from scientists from the University of Vienna (University of Vienna) together with researchers from the University natural resources and Life Sciences Vienna (University of Natural Resources and Life Sciences Vienna). Microrobots Cyberplasm Nanobots Ado Pune Magnetic nanorobot Spermbot Nanorobots for protein replacement
There are a huge number of specialized robots that perform individual tasks, without which it is impossible to imagine effective and high-quality treatment. Some of these devices are the Xenex Robotic Quartz Machine and the TRU-D SmartUVC Robotic Disinfector from Philips Healthcare. Undoubtedly, such devices are simply irreplaceable assistants in the fight against nosocomial infections and viruses, which are one of the most serious problems in medical institutions. Xenex robotic quartz device TRU-D SmartUVC Disinfecting Robot from Philips Healthcare Collecting a blood test is the most common medical procedure. The quality of the procedure depends on qualifications and physical condition medical worker. Often, trying to take blood the first time ends in failure. Therefore, to solve this problem, the Veebot robot was developed, which has computer vision, with which it determines the location of the vein and carefully guides the needle there. Veebot blood collection robot The Vomiting Larry vomiting robot allows you to study noroviruses, which cause 21 million illnesses, including symptoms of nausea, watery diarrhea, abdominal pain, loss of taste, general lethargy, weakness, muscle pain, headache, cough, low-grade fever, and, of course, severe vomiting. Vomiting Larry robot for studying vomiting The most popular robot for children remains PARO - a fluffy children's toy in the shape of a harp seal. The therapeutic robot can move its head and paws, recognize voice, intonation, touch, measure temperature and light in the room. Its competition is a huge cuddling teddy bear called HugBot, which measures your heart rate and blood pressure. PARO therapeutic robot HugBot robot bear A separate branch of medicine that deals with the diagnosis and treatment of diseases, injuries and disorders in animals is veterinary medicine. To train qualified professionals in this field, the College of Veterinary Medicine in the development of robotic pets creates unique robotic simulators in the form of dogs and cats. To get closer to the exact model of animal behavior, software is developed separately at the Center for Advanced computing systems at Cornell University (CAC). Robotic simulators in the form of dogs and cats Efficiency of robots in medicine:
It is obvious that the use of robots in medicine has a number of advantages over traditional treatment involving the human factor. The use of mechanical arms in surgery prevents many complications and errors during operations, shortens the postoperative recovery period, reduces the risk of infection of the patient and staff, eliminates large blood loss, reduces pain, and promotes a better cosmetic effect (small scars). Robotic medical assistants and rehabilitation robots make it possible to pay close attention to the patient during treatment, monitor the healing process, limit living staff from labor-intensive and unpleasant work, and allow the patient to feel like a full-fledged person. Innovative methods treatments and equipment bring us closer to healthier, safer and longer lives every day. Every year, the global market for medical robots is replenished with new devices and is undoubtedly growing. According to research company Research and Markets, by 2020 the market for rehabilitation robots, bioprostheses and exoskeletons alone will grow to $1.8 billion. The main boom in medical robots is expected after the adoption of a single standard ISO 13482, which will become a set of rules for design elements, materials and software, used in devices. Conclusion:
Without a doubt, we can say that medical robots are the future of medicine. The use of automated systems significantly reduces medical errors and reduces the shortage of medical personnel. Nanorobotics helps overcome severe diseases and prevent complications at an early stage, and widely use effective nanomedicines. Over the next 10-15 years, medicine will reach a new level using robotic care. Unfortunately, Ukraine is in a deplorable state with regard to this sector of development. For example, in Russia in Yekaterinburg, the famous robot surgeon “Da Vinci” performed its first operation back in 2007. And in 2012, President Dmitry Anatolyevich Medvedev instructed the Russian Ministry of Health, together with the Ministry of Industry and Trade, to work on the development of new medical technologies using robotics. This initiative was supported by the Russian Academy of Sciences. The reality is that in the absence of real support from the Ukrainian authorities in the development of the field of medical robotics, our state lags behind other civilized countries every year. This implies an indicator of the level of development of the country as a whole, because concern for the health and life of a citizen, mentioned in the main law - the Constitution of Ukraine, is the “highest social value”. LLC "OLME" St. Petersburg, Ph.D. Vagin A.A. Development of robotics in restorative medicine, rehabilitation of immobilized patients - problems and solutions. Competition today is determined not by the possession of large resources or production potential, but by the amount of knowledge accumulated by previous generations, the ability to structure it, manage it and personally use it. The modern concept of intelligent information systems involves the integration of electronic patient records with archives of medical images, monitoring data from medical devices, the results of the work of visa laboratories and tracking systems, the availability of modern means of information exchange (electronic hospital mail, Internet, video conferencing, etc.) .d.) . Currently, a promising preventive direction in the form of restorative medicine, formed on the basis of the principles of sanology and valeology, has received active formation and intensive development. High morbidity and mortality, a steady decline in the quality of life, and negative population growth contributed to the development and implementation of an independent preventive direction in practical medicine. However, the economic, social, legal, and medical institutions that exist today perform functions mainly for the treatment and rehabilitation of people with disabilities; they do not sufficiently address the issues of prevention and rehabilitation treatment of the disease. The economic and social situation in our country contributes to the emergence of feelings of fear and tension in the presence of injury or illness in a person, and is a source of psychosocial problems. The need to actively preserve health in the infrastructure of medical organizations is determined by the desire to bring medicine to a new stage of development. However, its further reform is difficult not only due to insufficient funding for this industry, but also due to clear uniform standards and methods of planning, pricing, and tariffs medical services, as well as the distribution of responsibility between executive authorities and its subjects for the implementation of certain volumes of medical care. Over the past decade, significant progress has been made in medical robotics. Today, several thousand operations on the prostate gland are performed using medical robots with the least possible trauma for patients. Medical robots make it possible to ensure minimal trauma in surgical operations, more fast recovery patients, minimal risk of infection and side effects. Although the number of medical procedures performed by robots is still relatively small, the next generation of robotics will be able to provide surgeons with greater ability to visualize the surgical field, provide feedback to surgical instruments, and will have a profound impact on advances in surgery. As the population ages, the number of people suffering from heart disease, stroke and other illnesses continues to rise. After a heart attack, stroke, or spinal injury, it is very important that the patient, as far as possible, exercise regularly. Unfortunately, the patient is usually forced to engage in physical therapy in a medical facility, which is often impossible. The next generation of medical robots will help patients perform at least some of the necessary exercise at home. Development of robotics in other countries. The European Commission recently launched a robotics development program with a €600 million investment to strengthen the manufacturing and service industries. Korea plans to invest $1 billion in the development of robotics over 10 years. Similar but smaller programs exist in Australia, Singapore and China. In the United States, funding for robotics research and development comes primarily from the defense industry, particularly for unmanned systems. But there are also programs for the development of robotics in the field of healthcare and services. Despite the fact that the industrial robotics industry was born in the USA, the world leadership in this field currently belongs to Japan and Europe. And it is not very clear how the United States will be able to maintain its leading position for a long time without a national commitment to the development and implementation of robotics technologies. Existing structural units carry out staged rehabilitation activities according to the principle: hospital – hospital-resort treatment – clinic. At the first stage of inpatient care for a patient, complications of an acute disease are eliminated and prevented, the process is stabilized, and physical and mental adaptation is carried out. The sanatorium-resort stage (II) is an intermediate link between the hospital and the clinic, where, with relative stabilization of clinical and laboratory parameters, medical rehabilitation of patients is carried out based on the use of healing natural factors. Stage III is a clinic, the main purpose of which is to modern level outpatient care to identify the compensatory capabilities of the body, their development within reasonable limits, and also to implement a set of measures aimed at combating risk factors for associated complications and worsening diseases. However, this assistance system is not always feasible in practice. The main difficulty is the significant economic and financial costs of hospitalizing patients, especially those with a borderline stage of the disease, the high cost of sanatorium-resort treatment, and insufficient equipment of clinics. modern methods examination and treatment. Currently, there are several international standards for recording clinical data in the MIS of medical institutions: IN last years in the United States, most large medical centers no longer operate without information systems (IS), which account for more than 10% of hospital costs. Research conducted over the past five years has made it possible to more fully understand the processes occurring during spinal cord injury and its consequences, as well as the principles of influencing the negative aspects occurring in the area of injury. Such close attention to this category of patients is explained by the severity of the consequences that arise during the process of injury and the subsequent further development of traumatic disease of the spinal cord. A morphological study of the injured spinal cord (SC) indicates that tissue damage is not limited to the area of impact of the destructive force, but, involving primarily intact areas, leads to the formation of more extensive damage. In this case, the structures of the brain, as well as the peripheral and autonomic nervous systems, are involved in the process. It has been established that sensory systems change much more deeply than motor systems. The modern concept of the pathogenesis of traumatic injury to the brain considers two main interrelated mechanisms of cell death: necrosis and apoptosis. Apoptosis is a mechanism of delayed (secondary) cell damage, which represents their physiological death, which is normally necessary for tissue renewal and differentiation. The development of apoptosis during SM injury is associated with the effect of excitatory amino acids (glutamate), Ca2+ ions, inflammatory mediators, ischemia, etc. on the cell genome. Disorders in the activity of a number of organs and systems that were not directly affected by trauma create new and diverse pathological situations. In denervated tissues, sensitivity to biological active substances(acetylcholine, adrenaline, etc.), the excitability of receptive fields increases, the membrane potential threshold decreases, and the content of ATP, glycogen, and creatine phosphate decreases. In paretic muscles, lipid and carbohydrate metabolism are disrupted, which affects their mechanical properties - extensibility and contractility, and contributes to rigidity. A disorder of mineral metabolism leads to the formation of paraosseous and periarticular ossifications, myositis ossificans, and osteoporosis. In parallel, another dynamic line is being formed - restorative-adaptive functional changes. In conditions of deep pathology, the optimal possible restructuring of mechanisms for ensuring adaptation to the environment occurs. The body moves to a new level of homeostasis. Under these conditions of hyperreactivity and tension, traumatic spinal cord disease (TSCD) is formed. All experimental procedures and manipulations were carried out in the operating room of the Department of Pathological Physiology of the Military Medical Academy under conditions that meet the requirements of SanPin 2.1.3.1375-03. The animals were placed on the operating table. Ether anesthesia was used. There were 22 rats in the control group (group A), and 21 and 22 in the main groups (groups B and C), respectively. All animals underwent partial (under ether anesthesia) denervation of the lower part of the spinal cord at the level of the 3rd thoracic vertebra. Experimental denervation in experimental animals was performed under sterile conditions in compliance with the rules of asepsis and antiseptics. To inflict spinal trauma on rats, only a 1.2x40 mm straight needle and suture material were used to apply a compression loop to the SC (supramid thread with a diameter of 0.1 mm, sterile). After inflicting experimental trauma on postoperative period animals of different groups were kept differently, but all were immersed in medicated sleep (Sol. Relanii 0.3 intraperitoneally, 2 times a day) for the entire observation period. The control group (A) was kept under standard conditions, and the rats of the main groups (B and C) were kept under conditions of fixation in a special cuvette. The device with the cuvette served as a prototype of the “optimal reducing environment” and consisted of a fixed bed made of a polyurethane pipe with a diameter of 5 cm, a length of 10 cm, cut along the length, leaving petals 5 cm long, 1 cm wide for fixing the animal’s paws. The petals of the cuvette are connected to moving arms of electric motors (4 pcs.), the rods of which perform linear movements allowing the animal to make specified movements with the paws of the animal (passive movements) through a relay device that receives commands from an industrial computer according to a given program. The animal was placed on its back in the described bed. His paws were fixed to the petals of the cuvette. Passive movements were carried out in the form of abduction and adduction of the animal’s limbs. Possible active movements in animals were carried out by them during periods of awakening. The experiment was carried out in two directions: As a result of histological and pathophysiological studies, the following results were obtained. In a histological study of sections of the spinal cord of rats in control group A, cell death as a result of injury after direct damage to the spinal cord occurs as a result of necrosis and lasts up to 14 days. Subsequently, cell death occurs as a result of apoptosis, which is observed up to 21-30 days with the formation of scar tissue. Scar tissue is formed from degenerated, chaotically located myelin fibers and axial cylinders that do not allow neuron axons to grow through the scarring area. The area of scar tissue formation includes the nuclei of cells that enter the stage of apoptoid bodies. At the same time, in the main group B* - (B and C) a clear histological picture of the restoration of neuroglial cells and neurons is revealed under the conditions of using the PDIC method. Practical testing of the experimental system on experimental animals led to the conclusion that a rehabilitation technique aimed at adequately using the discovered phenomenon of creating optimizing conditions for restoring the functions of the damaged SM should provide the following conditions: Analysis of the results of the experimental part of the work showed that the use of the method of constant long-term pulse kinetic therapy in the post-traumatic period in a clinical setting in patients with consequences of spinal injuries can stimulate the restoration of lost functions of organs and systems. When transferring the experimentally confirmed model of the optimal physiological environment to the clinical testing platform, we proceeded from the fact that the basis for developing a new method of rehabilitation treatment for such patients will have to solve the main rehabilitation problems: With the financial support of the company "OLME" LLC, a kinetic rehabilitation system was created that facilitates the automatic implementation of periodically generated irritation of the efferent and afferent pathways, the closure of the reflex arc and, thereby, the activation of the segmental reflex apparatus of the spinal cord through the same interval time, with the same force, in the same sequence around the clock throughout the entire time the patient is in rehabilitation (days, weeks, months and years) and allows preserving the joint-muscular system, peripheral nervous system and segmental apparatus, thereby allowing us to talk about new approaches to rehabilitation. Despite the lack of funding from the state, today the company “OLME” LLC has laid the foundations of robotics with information technology for the rehabilitation of immobilized patients for a long time at home in our country. This direction of development of rehabilitation makes it possible to significantly reduce mortality and disability in this category of patients, increase life expectancy and, in most cases, return to full-time work after 4-5 years. Bibliography:Equipment for rehabilitation in our company
Robot surgeon from UPM
A separate direction in the development of robotic medical equipment is the creation of transformable wheelchairs, automated beds and special vehicles for the disabled. Let us recall such developments as the chair with rubber tracks Unimo from the Japanese company Nano-Optonics, (Chiba Institute of Technology) under the leadership of Associate Professor Shuro Nakajima, which uses wheeled legs to overcome stairs or ditches, the Tek Robotic Mobilization Device robotic wheelchair from by Action Trackchair. Panasonic is ready to solve the problem of transferring a patient from a chair to a bed, which requires great physical effort from medical personnel. This device independently converts from a bed to a chair and vice versa when necessary. Murata Manufacturing Co has teamed up with Kowa to make an innovative medical vehicle, the Electric Walking Assist Car, an autonomous bicycle with a pendulum control system and a gyroscope. This development is mainly intended for the elderly and people who have problems walking. Separately, we note the series of Japanese RoboHelper robots from Muscle Actuator Motor Company, which are indispensable assistants to nurses in caring for bedridden patients. The devices are capable of lifting a person from a bed to a sitting position or picking up physical waste from a bedridden person, eliminating the use of pots and ducks.
Other specialized medical robots:
One of the important tasks of the World Health Organization (WHO) is the introduction of promising IITs with AI methods and tools for joint information interaction and use into clinical medicine.
Robotics is also beginning to be used in healthcare for early diagnosis of autism.
memory training in people with mental developmental disabilities.
In US healthcare, spending on information Technology is approximately 20 billion dollars per year. Of particular interest are medical systems that directly help doctors increase their work efficiency and improve the quality of patient care.
Necrosis is associated with direct primary damage to brain tissue at the time of application of traumatic force (contusion or compression of the brain parenchyma, discirculatory vascular disorders). The necrotic focus subsequently evolves into a glial-connective tissue scar, near which small cavities form in the distal and proximal parts of the SM, forming post-traumatic cysts of various sizes.
Initially, apoptosis of neurons is observed near the necrotic focus (peak death is 4-8 hours). Then apoptosis of micro- and oligodendroglia develops (the peak of death is the third day). The next peak of glial apoptosis is observed after 7-14 days at a distance from the injury site and is accompanied by the death of oligodendrocytes.
Secondary pathological changes include petechial hemorrhages and hemorrhagic necrosis, free radical oxidation of lipids, increased protease activity, inflammatory neurophagocytosis and tissue ischemia with further release of Ca2+ ions, excitatory amino acids, kinins, and serotonin. All this ultimately manifests itself in widespread ascending and descending degeneration and demyelination of nerve conductors, death of some axons and glia.
All this can cause new complications: bedsores, trophic ulcers, osteomyelitis, joint-muscular contractures, ankylosis, pathological fractures, bone deformities - in the musculoskeletal system; stone formation, reflux, inflammation, renal failure - in the urinary system. Connections are formed that are destructive in nature. There is oppression and functional loss of a number of systems that were not directly affected by the injury. Under the influence of a continuous flow of afferent impulses, active nervous structures fall into a state of parabiosis and become insensitive to specific impulses.
In order to test the assumption that there are ways to prevent the formation of scar tissue in the area of spinal cord injury, before the growth of neuron axons through it (working hypothesis), Alexander Anatolyevich Vagin carried out experimental work on Wistar rats. For the experiments, well-developed and healthy animals with good behavior, sexually mature, and one year of age were selected.
When processing statistical materials from the experimental pathophysiological part of the study, no recovery of pain and temperature sensitivity, as well as motor function, was noted in group A.
In group B* - (B and C), restoration of pain sensitivity was noted in 21.5% of cases, in 78.5% of cases there was no recovery. Restoration of temperature sensitivity was noted in 15.4% of experimental animals, in 84.6% of cases no recovery was noted. As a result of studying changes in motor activity, recovery was observed only in the main group B*. It was noted that movements in the limbs were restored in 26.2% of animals; in 73.8% of cases, recovery did not occur. According to the data of nonparametric analysis, the state of pain, temperature sensitivity, and motor function in the studied rats has a significant (p<0,05) влияние на комплекс реабилитационных лечебных мероприятий с использованием метода постоянной длительной импульсной кинетикотерапии. Все данные используемые в анализе измерялись в номинальной шкале, для которой используются следующие критерии: Фи, V Крамера и коэффициент сопряженности, подтверждающие выявленные значимости различий встречаемых параметров в исследуемых группах (р<0,05).
