Children with serious neurological conditions will benefit from the increasing global presence of Artificial Intelligence and robotics, with the opening of Australia's first robotic rehabilitation gym.

Two years of planning culminated in the opening of the gym at the Adelaide Women's and Children's Hospital in August,  featuring two robotic machines to help improve walking and hand-eye coordination, as well as develop muscle strength, power and range of arm movement.

"This is a gym that utilises robotic technologies to assist people with neurological impairments to achieve a higher functional level," says Associate Professor Ray Russo, Head of Research, Paediatric Rehabilitation Department, Adelaide Hospital.

"Robots are machines that can carry out a complex series of functions, usually under the control of a computer.

"This really helps when you are seeking repetition in a motivating environment as you can use feedback from the machines to generate visual cues to assist the person’s motivation."

This is the first Robotics Gym of its kind in Australia, utilising three key robotic technologies.

1. The Lokomat – a robotic device to support the participant in standing and help guide their walking practice to improve gait.
2. The Armeo – an upper limb robotic device used to improve upper limb function through the use of a support mechanism and computer gaming system.
3. The Dynavision – a visuo-motor training system used to improve upper limb function, balance and eye-hand coordination. The lab is also interested in innovative robotic technologies so we are on the lookout to assess other robotic and innovative devices that may assist functional recovery.

The use of robotic technology is effective in aiding the rehabilitation for any impairment in which many repetitions of an activity are required to improve functional outcome.

However, two other critical issues are support and sensory feedback, says Professor Russo.

"The robotic technologies can support a participant in maximising training effects. For example, the Lokomat can offer gait practice even if the person cannot stand well independently because of the supportive harness," he says.

"Also, the robotic technologies offer instant feedback - visual, auditory and sensory - through the apparatus and the computer screens that greatly assist progress in rehabilitation.

"For example, asking a child to 'use their quads' means nothing to them until they can literally see the changes on the feedback graph when they extend their knee, picked up by the robotic sensors on the Lokomat.

"The participant quickly learns that movement is what is required and this assists learning greatly, which can then be translated into real world functioning."

While the gym has only been operating a short time, anecdotal results show a positive outcome for patients.

"Patients have provided positive feedback about the use of the equipment, specifically the ‘gaming’ component, and improvements in their function and comfort," says onsite Physiotherapist and Australian Physiotherapy Association member Marianne Spizzo.

"Family and therapists have noted the high motivation levels for robotics, and this has been used to further challenge patients from strength and endurance perspectives, that have been more difficult to achieve in the traditional rehabilitation gym."

But while the use of robotic technology appears to offer a clear advantage to rehabilitation in this area, the presence of an qualified physiotherapist is crucial.

"The presence of a physiotherapist is critical in the set-up of the equipment itself and the set-up of the patient in the equipment," says Ms Spizzo.  

"Furthermore once the set-up is complete, the physiotherapist needs to make constant adjustments to the hardware and software components to ensure the rehabilitation capacity of the patient and the equipment is maximised and any safety concerns minimised. 

"Although further high quality research is needed, the current evidence suggests that over-ground training is needed to ensure translation of the skills acquired whilst using robotics to real life activities, and this will still require the skills of a therapist."

Due to the high cost of the technology, robotics are not commonly utilised, however as prices reduce over time robotics are expected to become more prevalent in the rehabilitation process.

"Robotics have already undergone revolutionary changes as a technology that was only used to assist people with neurological impairments to complete functional activities, to one where they are being used to improve functional outcome for patients," says Professor Russo.

"This has been a major advance and now with their application occurring more broadly the field is growing.

"In the future, as with most technologies, prices for the robotics will reduce making them more available and technological advances will lead to better robotics.

"For these reasons robotic technologies in rehabilitation of people with neurological disabilities is seen as a growth area with great potential."