Featured Project: Diagnostic robot simultaneously measures multiple impediments to arm movement

Monday, July 5, 2021

Name: Regain self-management by better understanding of paretic ARM function (Re-ARM)
Goal: Analysis of practical needs and clinical added value of diagnostic robot Re-Arm
Intended outcome: Objectively diagnose movement disabilities of arm rehab patients in clinical practice to better tailor treatment plans to individual rehab patients
Partners: Erasmus MC, TU Delft (Medical Delta: Improving Mobility with Technology); Rijndam Rehabilitation (Medical Delta Living Lab Rehabilitation Technology); Hankamp Rehab
Status: Grant application for clinical implementation of prototype in the making

In people with congenital brain damage or people who have had a stroke, arm function may be limited. A proper diagnosis of the movement problem is important for effective treatment. This is largely based on the knowledge and experience of therapists. Under the name 'project Re-ARM', scientists, rehabilitation physicians, physiotherapists and the company Hankamp Rehab are developing a diagnostic robot with which objective and scientifically validated measurements of arm function can be made.

Scientists from Erasmus MC and TU Delft who work together in the scientific program Medical Delta: Improving Mobility with Technology are involved in the project, for which Hankamp Rehab developed the first prototype. Soon they hope to be able to use this at the Medical Delta Living Lab Rehabilitation Technology, where therapists from Rijndam will work with the prototype.

The first clinical validation of this prototype at Erasmus MC in collaboration with Rijndam was successful: the device measures the right things in the right way and can contribute to a good diagnosis. The prototype measures the muscle weakness, spasticity, stiffness and synergy of the elbow. This creates an objective picture of the patient's arm function. It is expected that this will enable a better and more personalized diagnosis and treatment plan to be realized than in current clinical practice, where doctors and therapists look and feel how the arm moves and what the obstacles are on the basis of arm exercises.

Added value for healthcare practice

Researcher Levinia van der Velden is developing a scientific method to make a better diagnosis of impaired arm function. Now that a first prototype has been completed, the researchers involved want to further optimize the diagnostic robot so that it is easier to use for doctors and therapists. The next step in the development process is to determine whether the device and the methodology actually have added value in healthcare practice. How do you organize the deployment of this device? Is it workable for therapists in healthcare practice? And does it deliver the promised measurement value? And does a better diagnosis also lead to better treatment and therefore better outcomes? In order to be able to determine this properly, it is the wish to investigate the application of the device in the clinical practice of Rijndam Rehabilitation.

As a technical physician and former physiotherapist, Van der Velden has an interdisciplinary background. This is clearly reflected in her research, in which she involved clinicians, engineers and physiotherapists, including physiotherapist Marc Evers (Rijndam Rehabilitation). According to him, the current methods are multi-interpretable and there is a need for more insight into what is the best approach for treatment for a specific patient. “If spasticity is the biggest problem, it requires a different treatment than when another aspect predominates. There are instruments for, for example, measuring spasticity and also to map muscle strength or synergy, but this device looks at the total so that the mutual relationship is also visible. It remains to be seen whether this adds value to the treatment.”

Improvement of usability

On the technological side, engineers Claudia Haarman and Koen Heuver of Hankamp ReHab developed the first prototype. dr. ir. Mark van de Ruit of TU Delft is involved in the further development of this as part of his NWO VENI project, and is devising new ways to quantify the arm function. For him, the clinical validation is important to know whether the project can continue on the chosen path. “We look at whether the outcome measures are clinically valuable, or whether other information is needed, and how we can optimize the user-friendliness and technology.”

For this final phase, the project team, together with the doctors and therapists, want to improve the user-friendliness and operation of the device. “Ultimately, the device has to prove its added value in clinical practice,” says Van der Velden. “We want to see if it's worth the time it takes to use the device: do the therapists and doctors handle it well? Does it fit into the existing treatment setting? And does its use provide enough new insights to improve the treatment process?

The project team wants to register for a subsidy call for this final project phase. When this last phase has been completed, it will become clear whether the device offers sufficient added value to eventually enter the healthcare market.

More information (in Dutch only) about the project can be found on the sites of Rijndam Revalidatie and Hankamp Rehab.

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