Q&A with Sunil Agarwal
October 13, 2017
Columbia Technology Ventures (CTV) spoke with Sunil Agrawal, Professor of Mechanical Engineering, about his work in medical rehabilitative robotics.
CTV: How can conventional medical rehabilitation benefit from a robotic overhaul?
SA: There are so many reasons people seek physical therapy—to recover function after common injuries to a knee or a shoulder, for example, or for intensive rehabilitation related to serious conditions like a stroke or ALS, or even chronic conditions like cerebral palsy. Regardless of the reason for treatment, we can design robots that capture the essence of many therapeutic techniques, incorporating them into a tool that enhances the process for both therapists and patients. The robots can be programmed to challenge the users as per their needs and outcomes. The traditional rehabilitation is very qualitative. The therapist can watch a patient perform exercises and form an opinion that the patient is improving, but the question they can’t answer is how much better are they? Where are the quantitative measures? A rehabilitative robot can provide constant feedback in the form of data that quantitatively show how well the patient is responding to treatment, which is motivating for the patient and can help the therapist adjust the program and treatment course accordingly. In addition, we can design wearable robots that provide data continuously to assess outcomes, as necessary.
Another very important factor here is that people recovering from major injuries or strokes, or children with cerebral palsy, require a lot of therapy, which takes time, costs money, and requires a significant number of physical therapists. It’s intensive work, and the amount of therapy that’s most beneficial for patients is not always available or covered by insurance. Our vision for these robotic rehabilitative devices is that they will allow patients to continue their therapy at home, so they’re not tied to the clinic, and each physical therapist could potentially work with many more patients.
CTV: You’re doing some fascinating work on gait-training exoskeletons. Tell us about these devices and patients that may benefit from them.
SA: Gait-training exoskeletons are wearable robotic devices that a patient straps to his or her legs to assist with mobility. There are several stages to each step we take, and if you’re not completing each one, it affects mobility. For example, some patients don’t swing their legs far enough from the body with each step—their range of motion is too small—and it affects their balance and ability to walk well. Our exoskeletons, which we call ALEX, for Active Leg Exoskeleton, can sense these gait imbalances and actively correct them by applying external forces, just like a physical therapist would do. The robotic system can actually train or re-train the body to learn how to walk—it’s an incredible thing to watch. This approach can be adapted to treat a wide range of patients, from those suffering from strokes and cerebral palsy to the elderly.
CTV: You mentioned watching patients use the exoskeletons—what kind of testing have you done?
SA: This is one of the big advantages to being at Columbia—we have active robotics labs both on the engineering campus and the medical campus, and we collaborate closely with clinical staff and patients at Columbia University Medical Center. We’ve been able to test and refine ALEX through trials with a variety of patients receiving rehabilitative services at the hospital, and the feedback has been invaluable. Patients have also been integral to the development of another innovation we’re very excited about, the Tethered Pelvic Assist Device, or TPAD.
CTV: What is TPAD?
SA: The Tethered Pelvic Assist Device, which we call TPAD, is a technology that stabilizes the pelvis during walking. It’s similar to a belt that’s worn around the waist, and the device is pulled by wires that apply beneficial force to stabilize the pelvis. For example, if someone has a stroke, they’ll often shy away putting weight on their weaker side, but this device would force weight onto that side to help build strength and coordination. This is a technology we developed here at Columbia and we’ve conducted small trials to test the device on children with cerebral palsy and stroke patients. The results have been very exciting.
CTV: How close are these devices to commercialization?
SA: The cost of creating these devices is certainly coming down, and the clinical results have been promising, so we are hopeful we can continue that trend and bring these assist devices to patients. Some of our devices, including TPAD, a spinal brace we’ve designed for scoliosis patients, a neck brace for ALS patients, are already at the point where we can use a 3D printer to create them in our lab on an individual basis, so they’re infinitely customizable and interchangeable. It’s important to remember that this is a very new field—just ten years ago, there was very little presence for robots in rehabilitative medicine. Today, there’s a growing appreciation that these technologies can be very impactful. By 2050, we will have the largest number of people over age 65 than at any other time in human history, and this is one demographic where these technologies can really help. There’s going to be a real shortage of caregivers and care providers, so there’s a strong, growing trend to increase the market for solutions in these areas.
Columbia Technology Ventures works closely with Columbia researches to commercialize early-stage technology innovations, connecting industry and investment partners with researchers to bring impactful, in-demand robotic technologies to market as quickly as possible. To see Columbia’s Robotics portfolio available for licensing please click here: http://innovation.columbia.edu/robotics
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