Japan: Leading the Way in Elderly Care with Rehabilitation Robots

By Lingjun Kong

The use of assistive and therapy robots in rehabilitation has r a p i d l y evolved in Japan for several reasons. There is a growing need for improved technology as the average age of the country’s population is quickly increasing. Due to a falling birth rate, a miniscule net immigration, and one of the highest life expectancies in the world, over a quarter of Japan’s population is expected to be 65 years or older by the year 2020. The aging society has created an increased demand for the development of practical robotics applications in lifestyle-related areas, specifically healthcare. The tradition of having the young take care of the old has shown to be inadequate and is steadily declining in the culture. Moreover, many children of the elderly may be aging as well, and are in need of caring for themselves. Thus, robotics has been a commonly sought solution for the care and treatment of the aging population in Japan.

Fortunately, Japan has been the leading pioneer in robotics in the past few decades, especially with humanoid machines. Many of its citizens grew up watching cartoons with robot protagonists, which corresponds with the country’s many technological advancements in humanoid robotics. The International Robot Exhibition is the largest robot trade fair in the world and is held annually in Tokyo due to the multitudes of exhibits from Japanese researchers. A few of the recent unveilings include the newest model of Actroid, originally developed by Osaka University, modeled after a young woman of Japanese descent that can mimic speaking, breathing, and blinking, and Telenoid R1 Robots, created by Dr. Hiroshi Ishiguro at Osaka University, which are humanoids that can sense facial expressions and mirror them with their own face. Currently, Japan occupies a dominant position in the global robotics market; 70% of the world’s industrial robots are made by Japanese companies. For many years, the use of robotics in Japan has deeply penetrated the medical field. From surgical robots used in coronary artery bypass operations to androids used as test subjects in medical school and robot nurses used in retirement houses, automated technology is found in various forms of healthcare. This is especially due to the increasing number of disabling age-related diseases, such as stroke and other chronic diseases. Rehabilitation, in particular, has been one area where robotics has truly shined.

Prosthetics and robotic devices for locomotion and manipulation aids have been widely developed in Japan for physical rehabilitation purposes. Many studies have focused on a robotic hand that has sensory capabilities and neuromuscular controls. These studies have led to the development of several different forms of hand devices, including exoskeletons that are worn by the human hand, haptic devices that interact with the human hand, and prosthetics that imitate the human hand. Similar products have also been developed for lower limb rehabilitation as well. In addition to mind-controlled wheelchairs to aid in mobility, exoskeletons that support the legs are used as gait trainers to regain walking ability. Active knee and ankle joints give flexibility and mobility to those with lower extremity disabilities. Recently, high performance actuator technologies and control strategies have greatly improved robot- assisted gait rehabilitation for mobility and manipulation rehabilitation. Exoskeleton- based orthoses, such as knee-ankle-foot orthosis, hip-knee-ankle orthosis, and polycentric knee orthosis, now move much more smoothly and comfortably. Furthermore, robot- aided assessment and feedback present patients’ gait performance in feedback values with the use of the robot device sensors, ultimately helping the patients adapt their movement patterns and improving the user experience.

Robotic mechanical devices are being effectively applied not only to physical rehabilitation, but to cognitive rehabilitation as well. A great example is the use of the mirror neuron system for the revitalization of the control of upper extremity muscles after stroke. The mirror neuron system encourages the development of motor neurons through imitation. Observation followed by execution is a more effective method for gaining motor memory compared to motor training alone because observing another’s movements activates the primary motor cortex, the premotor cortex, and the appropriate muscles. Repetitive use of this biological system through observation and execution, known as “mirror therapy,” can help stroke patients regain the ability to control their limbs through the aid of robotic devices to support movement. Recent clinical results have shown that the use of therapeutic robotics is an effective method for post-stroke rehabilitation.

Virtual Reality (VR) has recently been utilized to supplement robot-assisted therapy and treatments. At research centers such as Osaka University and Gifu University, rehabilitation systems are now equipped so when patients are placed in a virtual environment and equipped with haptic devices, patient interactions with objects in the virtual environment will actually generate feedback forces. This interactive rehabilitation gives disabled patients a method of enabling muscle and bone to regain strength through repetition and goal-oriented objectives. By taking advantage of the plasticity of the brain to help rewire damaged neuronal networks and exercising limbs, combining robotics and VR can improve patient performance in both cognitive and physical treatments. In addition, the visual feedback of the virtual world provides a more interactive experience to enhance training outcomes.

There are many technical difficulties to be overcome with the expanding field of rehabilitation robots; however, the real challenge is to help people live happier, longer lives. In a place with high healthcare costs and limited human therapeutic services, the development of assistive and therapeutic robots is more than necessary to aid the aging population. As the rest of the world faces similar situations, Japan’s pioneering advancements in robotic rehabilitation will lead the way towards a better quality of life.

Lingjun Kong, PMP                                                                                                       Virtual Reality Medical Center                                                                                       U.S.A.                                                                                                         lkong@vrphobia.com                                                                             www.vrphobia.com