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Physical therapy faculty, students at IUPUI work with advanced robots to treat patients with neurological impairments



INDIANAPOLIS– IU Department of Physical Therapy faculty and students are researching how best to use advanced rehabilitation robots — available in only a handful of locations in the U.S. — to treat children and adults with traumatic brain injuries, strokes, cerebral palsy and other neurological impairments.

Their work focuses on five robots and three other pieces of innovative technology in the Advanced Neurorehabilitation Research Laboratory at the IU Health Neuroscience Center on 16th Street in Indianapolis. The lab opened in 2013.

The Advanced Neurorehabilitation Research Lab is a collaborative effort between the Department of Physical Therapy in the IU School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis and Neurorehabilitation and Robotics, a clinic of Rehabilitation Services at IU Health Neuroscience Center, which staffs the facility with physical, occupational and speech therapists. The lab was made possible by contributions from Robots to the Rescue, Riley Children’s Foundation, Methodist Health Foundation and the United Cerebral Palsy Association of Greater Indiana.

“The lab is a leader in the Midwest relative to implementing this type of technology in the rehabilitation world, so much so that it will host a workshop next year on advanced technology and how it is impacting neurological recovery,” said Peter Altenburger, assistant professor and co-chair, Department of Physical Therapy,  and research director,  Indiana Center for Advanced Neurorehabilitation, Neurorehabilitation and Robotics at the IU Health Neuroscience Center.

“It puts the physical therapy department in a situation where it is able to attract high-quality students who want the opportunity to experience this type of technology and this type of application for rehabilitation purposes,” he said. “It attracts patients from across the state because they can’t get this type of treatment anywhere else and, in terms of leadership in the health arena, it is unequaled.”

“Within the lab and clinic, physical therapy faculty, students and IU Health therapists work together to determine best ways to use the advanced technology to assist patients,” said Ryan Cardinal, program manager for Neurorehabilitation and Robotics and adjunct faculty member of the physical therapy department. “Therapists are creating outcomes, which drives new questions about use of the robots. Faculty and students research answers to those questions.”

In addition to research, physical therapy students attend classes at the lab, have internships there and participate in clinical rotations, Altenburger said.

“The lab gives us the opportunity to explore research questions that others don’t have opportunity to explore because they don’t have same equipment we do,” Cardinal said.

Rehabilitation robots were introduced about five year years ago to researchers and therapists on the IUPUI campus, Altenburger said. “But there are still questions being investigated about how best to utilize the equipment.”

Among the questions are how much treatment is the right amount; how often should treatment on a robotic device be provided; is more treatment better; and is there a limit after which there is no benefit, he said.

Some of the questions stem from the abilities of a therapist to physically help a patient make a particular movement, compared to the ability of a robot. Therapists using a traditional approach might be able to help a patient take 100 steps during an hourlong session. But a robot is capable of helping that same patient take up to 1,000 steps in an hour.

There is no confusing the rehabilitation robots with R2’D2 of “Star Wars.” The devices are considered robotic because a computer system drives an end-effector or exoskeleton and have their own internal engine or power for movement. The robots are manipulated by a therapist who defines the movement they create.

The Lokomat, one of the robots at the lab, assists patients with walking. A patient is suspended in a harness over a treadmill. The frame of the $400,000 machine moves the legs in a natural walking pattern, with a therapist using a computer to control the pace of walking and measuring the body’s response to the movement.

“It replicates what walking feels like, is more consistent, lasts longer and enables the patient to take far more steps than if I was crawling on the floor behind the patient, using my hands to help the patient move his legs,” Altenburger said.

Other robots at the lab include one that focuses on the shoulder-elbow, another on the wrist and a third on the full upper extremity. A fifth robotic device focuses on the ankle.

“The technology lends itself to repetition training, building on motor learning and neuroplasticity,” Cardinal said. “Our equipment is geared toward assisting someone, like a patient who has experienced a stroke, retrain pathways in the brain to regain a walking pattern. Research shows that lots of repetition and practice, practicing the same thing over and over again, enhances the ability to do that activity.”