Robotic Support for Motion: Robotic Rehabilitation

Robotic rehabilitation, which is used to eliminate motion losses that develop after disorders such as stroke – paralysis, Brain damage, Spinal injury, Parkinson’s Disease, Brain tumor surgery and MS, may help the patients walk within a short time.

Treatment approaches, which were utopic and resembled science fiction some time ago, are becoming true with the cooperation of developing technology and medicine. Following the use of robotic systems in surgical treatment, this technology helps the patients also in physiotherapy and rehabilitation. With robotic rehabilitation practices, the patients having motion problems due to diseases primarily with neurologic and orthopedic causes can continue their lives just as they did in the past after surgical or medical treatment. We learned the frequently questioned issues about this treatment from Physiotherapy and Rehabilitation Specialist Prof. Engin Çakar, MD who is the head of the Robotic Rehabilitation Center of Memorial Şişli Hospital.

What is the difference of this center from the ordinary physiotherapy and rehabilitation centers?

Turkey has become a regional power and attraction focus in healthcare in the recent years. Turkey is drawing attraction in the whole World with high quality treatment possibilities especially in certain medical disciplines. The Robotic Rehabilitation Center of the Memorial Şişli Hospital was designed and established as a clinic with the highest level of capabilities in the World being specialized in “neurorehabilitation”, “sports and rehabilitation” and “pain treatment” field.  

In establishing this center, the foremost physiotherapy and rehabilitation centers , in our country, in the USA and in Europe were examined and a model with a medical and technological infrastructure that would be an attraction point, both in our country and in the whole region was created. While the center was being established, special attention was also paid to creating a young and dynamic team experienced in this field.

Our Robotic Rehabilitation Center has accepted patients from Great Britain, Romania, Bulgaria, Germany, Georgia, Azerbaijan, Iraq and Libya besides our citizens even in the first month after it was established. It has started to become an international attraction point in physiotherapy and rehabilitation area in health tourism. 

In the neurorehabilitation area, the medical treatment and rehabilitation of all neurologic diseases particularly of stroke-paralysis due to brain vascular occlusion or cerebral hemorrhage, brain damage, Parkinson’s disease, spinal injury, function losses due to brain tumor or MS can be performed. A very simple principle is at stake in these diseases associated with the brain: “USE OR LOSE”. Thus, it is tried to put the patients on the road to recovery immediately in the early period with the classical physiotherapy and rehabilitation practices combined with robotic ones. At this point, all blood pressure parameters of the patient are followed up by robotic bed and stimulation with robotic assisted walking and electrical currents is provided when standing up in the early period. The patient is rehabilitated for hand motions simultaneously with hand-arm robot integrated with virtual reality. In this process, classical occupational therapy is continued with physiotherapy. When the patient is ready, supported walking with virtual reality integrated walking robot is started rapidly. The most significant feature of the walking robot is that it perceives the motion that can be done by the patient and provides opportunity for physiotherapy with active participation with the needed amount of help.  

In the sports and rehabilitation area, all non-surgical treatments of the diseases of the musculoskeletal and nervous system and physiotherapy, and rehabilitation practices before and after cases requiring surgery are carried out. Especially in joint, muscle and cartilage problems, with the computer-assisted measurement of the muscle strength and endurance of the associated region and with specific physiotherapy programs prepared accordingly, a rapid recovery can be provided. Additionally, tissue renewing regenerative treatments such as prolotherapy, PRP and stem cell treatments may be applied in joint, cartilage and muscle problems when needed. With anti-gravity treadmill, the weight of the patient can be reduced by up to 80% against gravity and the practice of the appropriate exercise program is enabled without excessive load on the muscles and joints. With isokinetic test-exercise system, the muscle strength and

endurance in all muscles can be measured by a computerized system and rapid and complete recovery may be provided with a suitable physiotherapy program integrated with this system.  

In the pain treatment unit, special importance is given to the issue of the correct determination and appropriate treatment of the problem in acute low back-neck, joint pain and especially in prolonged low back-neck and shoulder-knee-hip joint problems. At this point, in addition to all physical treatment methods, posture analysis and training, spinal health training, joint health training are also given. Neural prolotherapy in prolonged head-neck, low back pain, prolotherapy and prolotherapy with PRP practices in prolonged low back pain and prolotherapy with PRP practices and stem cell practices in cases such as calcification of knee joint and cartilage damage are among the treatments given.

What kind of advantages does the robotic rehabilitation provide for the patient?

For example, let’s suppose that a patient had stroke or paralysis due to cerebral hemorrhage or that he/she had brain damage or brain tumor surgery but leg-arm coordination or muscle strength weakness has developed due to the removal of the tumor. When these patients are left by themselves, they give up trying these movements when they cannot perform them. This is called “learned non-use”.

Intensive medical treatment is given to these patients in the first 3-7. Simultaneously, the patients are made to perform some exercises in their rooms. When the medical status becomes stable, robotic bed treatment is started. The priority here is the upright position and walking of the patient. One of the reasons for this practice is to prevent the brain from forgetting motion ability with early mobilization. 

What are the advantages of early walking with robotic bed?

Contractions called spasm-spasticity, decrease in joint motions, shortening especially in the ankle tendon, decubitus wounds, low or fluctuating blood pressure, infection and occlusion in the vessels may be counted among the problems frequently encountered in the 

patients who have been in bed for a long time. Early walking with robotic bed and the stimulation of the muscles with simultaneous electrical stimulation provide significant contributions in the prevention of these.

What is the re-learning of correct walking by playing?

In the patients who can tolerate upright posture, robotic walking integrated with virtual reality is started. During this practice, a specific ratio of the body weight is removed. Some of the motions are performed by the patient and the ones that cannot be done by the patient are perceived by a sensor and performed by the robot. With virtual reality, the patient is faced with his/her avatar. The treatment of the patient is given by playing games in the natural environment with the help of virtual reality. Thus, this constitutes a treatment approach providing high motivation. Thanks to this application with 30-40 games, the patient walks among the trees, animals in the garden, picks up apples, cuts a watermelon etc. All these physical treatment practices are done for the patient to regain motion as soon as possible and to fulfill his/her daily activities.  

Can you tell about the significance of the hand-arm robot in the treatment?

Primarily, learned non-use is prevented. The motions are performed continuously and repeatedly. Thus, when the patient is recovering, he/she can respond to orders such as “move your arm” or “extend your arm”. However, even if he/she can bend his/her fingers, he/she may not be able to hold a cup, that is he /she may not be able to unite the different segments of a motion. A fast and correct physiotherapy with hand-arm robot enables the re-coding of these motions in the brain by a correct way. This is possible by frequent repetition.

How does anti-gravity treadmill help?

When the patient is unable to bear his/her own weight, the anti-gravity treadmill eliminates 80% of his/her weight. Thus, the joints can move with greater ease. This is also called “space walking”. For example, a patient who has not been able to move from a chair to another without the help of two people for years, can start to walk when 50-80 percent of his/her weight is removed. This is because the legs of the patient have the strength to bear less weight than his/her actual weight. With this device, the muscle is made to work again without being under compression or stress.

 What is the Cybex system, which is indispensable in athlete rehabilitation?

This is in fact a system that enables the measurement of the strength and endurance of the muscles making the joints move and their development with computer-assisted programs. In our center, this opportunity is provided for the treatment of all patients experiencing muscle-joint problems besides professional athletes. Its contribution in achieving success in physical treatments of the athletes is very significant. 

What is the ultimate aim of robotic physiotherapy and rehabilitation?

The basic aim of the center is to enable the patient to return to his/her social and work life without experiencing pain and with no dependence on others and to carry out his/her responsibilities independently as an individual. 


When the patients who are not under rehabilitation are left by themselves, they may give up trying to move. When the body sees that the muscles and joints are not used, a very simple principle works: “use or lose”. In the end “learned non-use” status develops.  


In robotic rehabilitation, avatar appears here with virtual reality integration. The patient plays games by trying to commend his/her avatar in the image and develops his/her muscles.


The devices are being developed by time 

The products used in Memorial Şişli Hospital Robotic Rehabilitation Center have the latest technology in their field and they are unique in Turkey.  Prof. Engin Çakar, MD tells that they work with two worldwide brands from Switzerland and USA and gives this information: “The devices used are continuously developed. The first version of the walking robot was enabling simple walking while in the second version, the correction of the walking route was started. Virtual reality games were increased in the next one. The one used in our center at the moment has freeD feature. It does the physiological motions of the pelvic region, too. The devices used in the past were enabling only fixed low back and hip motions. However, with the technology of today, the one that is closest to physiologic walking and giving the same type of swinging when we walk on a normal road is given. Hand-arm robot also develops within itself. It can now do the grasping of the hand.


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