A robotic wheelchair helps to improve the physical condition of people with duchenne muscular dystrophy

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How can healthcare robotics help patients with Duchenne muscular dystrophy (DMD)? This inherited neuromuscular disease affects one in every 3,500 children worldwide. It causes gradual loss of muscle function and therefore leads to progressive disability. Despite advances in treatment, these patients have an average life expectancy of 35 years and usually have to start using an electric wheelchair during adolescence.

Power wheelchairs are an essential technology to support mobility and maintain independence and social participation. However, their continuous use leads to a high degree of sedentarism, which in turn leads to secondary functional deterioration of musculoskeletal and cardiorespiratory systems and accelerated loss of arm function. 

An appropriate long-term dose of dynamic physical training can help to preserve the functional capacity of people with Duchenne muscular dystrophy. The wheelchair developed as part of the MOVit project has two robotic arms instead of armrests. The system enables people with Duchenne muscular dystrophy to control the direction and speed of the wheelchair by cyclical movements of their arms, without using any other driving method. 

In this way, the MOVit system replaces the usual joystick for controlling and driving wheelchairs and provides patients with the opportunity to exercise their arm muscles while they drive; muscles that suffer from a loss of tone caused by the disease. In addition, the system can adapt the form of driving with the arms to each person’s activity and physical training needs. 

The system was developed through the work of the team of Joan Lobo, who was then a researcher in the Perception and Manipulation Group at the Institute of Robotics and Industrial Informatics (IRI), a joint research centre of the Spanish National Research Council (CSIC) and the Universitat Politècnica de Catalunya · BarcelonaTech (UPC); Julita Medina, doctor in the Rehabilitation and Physical Medicine Service of Hospital Sant Joan de Déu and researcher at the Sant Joan de Déu Research Institute (IRSJD), and the researcher Josep M. Font, from the Department of Mechanical Engineering and the Research Centre for Biomedical Engineering (CREB) at the UPC. The project was supported by the University of California Irvine (UCI) and the association of families Duchenne Parent Project Netherlands, which funded the robotic wheelchair MOVit.

Dynamic, tailored physical training

International guidelines on treating Duchenne muscular dystrophy recommend carrying out certain activities regularly and avoiding other high-intensity exercises. Although there is no consensus on the specific pattern of physical exercise that should be followed, one study showed that an appropriate, long-term pattern of dynamic physical training (assisted cycling training of legs and arms for six months) could help to maintain the functional capacities of people with Duchenne muscular dystrophy.

Currently, people who use power or manual wheelchairs have to move or be moved to the training devices or machines and then exercise for a fixed amount of time. In contrast, people without disabilities have many opportunities to integrate exercise into their daily life: cycling or walking to work, walking up steps, etc. Integrated daily exercise is one of the most effective ways of promoting health and well-being. 

Young people aged between 12 and 18 with Duchenne muscular dystrophy participated between July and November 2019 in the pilot study of the MOVit project, carried out in the CREB Biomechanical Engineering Lab at the UPC, in the Barcelona School of Industrial Engineering (ETSEIB). In the study, it was checked whether the wheelchair could be controlled correctly by arm movement and driving skills were compared with those using a standard joystick. The study showed how the various levels of resistance, speed and amplitude of movement affect heart rate and the activation of the arm muscles.

Driving based on arm movements

The final result was the development of the MOVit system: a wheelchair with two robotic arm supports that is driven directly by circular movements of the person’s arms. Right arm movement controls the speed of the right wheel of the chair and left arm movement controls the speed of the left wheel. The turning direction of the chair can be altered by pressing a button that is on the upper part of the arm support. 

Other driving tests carried out with a prototype of the MOVit system in a group of 24 healthy people showed that, after a 30-minute training period, they could drive the chair with a speed and precision similar to those achieved with a joystick. Heart rate and oxygen consumption data indicated that the MOVit system can provide low-intensity exercise similar to walking.

‘MOVit’ Game: an interactive game platform

One continuation of the ‘MOVit’ project is the development of MOVit Game; an interactive game to motivate patients to complete physical training and physiotherapy exercises, which tend to be monotonous and repetitive and therefore not very attractive.

The aim is to provide people with Duchenne muscular dystrophy with an interactive platform to undertake physical exercise in a controlled way. The platform will be used in combination with the MOVit wheelchair. In this case, the project is funded by the Duchenne Parent Project Spain, and is also being developed by Joan Lobo, currently a rehabilitation technology engineer in the spin-off Able Human Motion (that emerged from the UPC), together with Josep M. Font, who is the head of this company and the CREB Biomechanical Engineering Lab, as well as the researchers Dani Tost, head of the Computer Graphics Area of the CREB, and Carme Torras, from the Perception and Manipulation research group at the IRI. The project is supervised by doctor Julita Medina, from the Hospital Sant Joan de Déu and the IRSJD.

The gaming platform will have a narrative plot based on the paradigm of searching for and gathering objects. The best way to present these objects will be presented, whether it is interactive projection, a mobile robot and/or virtual reality glasses.

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