What is a stroke?
A meeting 20 years ago between two academics from opposite ends of campus sparked a research programme which is offering new hope to stroke survivors.
The idea was the brainchild of medic Bipin Bhakta, who believed robots had the potential to revolutionise the physiotherapy which was given to people who had suffered strokes.
Typically a stroke destroys vital connections which allow us to carry out basic motor tasks. Physiotherapy is aimed at rebuilding neural pathways, so that patients re-learn how to send signals from their brain to their hands and arms and regain the function they enjoyed before the stroke. But to make the physiotherapy most effective, it needs to be delivered more often and for longer than the short, infrequent sessions that are typically offered to NHS patients.
Dr Bhakta – later Professor of Rehabilitation Medicine – saw robots as the ideal way to overcome this, and he called on the help of young engineer Dr Martin Levesley. “He asked if we could build a robot which would mimic the work of a physiotherapist and help people who have suffered strokes to regain the use their arms and hands,” says Martin, now Professor of Dynamics and Control. “He said ‘You’re an engineer, how hard can it be?’ It was a fascinating challenge.”
The work addressed a particular need for the stroke patients who Dr Bhakta treated at his clinics in the Leeds Teaching Hospital NHS Trust. While it is crucial to the patients’ independence, physiotherapy on the upper limbs is not the prime focus of their treatment. Instead, the NHS – pressed for space and resources – is focussed on patients’ lower limb movement, so they can be up and moving and receive their care at home.
Once home, the rehabilitation continues, though for their upper limb movement, stroke patients receive only short one-to-one physiotherapy sessions. And while they may be prescribed an exercise regime to follow at home, patients often find this dull and repetitive.
Bipin saw robotics as the way to overcome these challenges. A device which patients could use in their own home would give them physiotherapy as frequently and for as long as they wish without the need to visit hospital; by linking the device to a computer screen the exercises could be made more stimulating and interesting.
After years of research, testing, trial – and plenty of error – Martin and his team have built MyPAM, a robotic joystick which patients can use in their own home to complement the hands-on treatment they receive from their physio.
The exercises take the form of a computer game, where the user moves a cursor around the screen by controlling a joystick, rather than a mouse. The Leeds team has created a virtual world in which users attend to an on-screen garden – and where the robot arm allows you to effectively rake the lawn, sow the seeds and water the plants, each of them being a valuable use of their limbs.
Another game is set within a wacky world of banana-grabbing monkeys – and the Leeds researchers are creating new games to make the exercises as interesting and compelling as possible for the users
Initially, the robot moves the patient’s arm by itself, but in time, as the patient gains their own strength and movement, they begin to control the robot themselves. The robot is programmed to react to how the patient is responding to the treatment to gradually offer them more and more independence of movement. The results are then sent remotely for a therapist to examine.
Trials of the device yielded promising results. Seventeen patients were given the robot to use in their own homes over a period of six to eight weeks – and in almost every case it proved MyPAM was a success by giving them access to physiotherapy at home – as frequently and for as long as they wished. “We have clinically significant data to show that people’s upper limb movement has improved,” says Martin. Crucially, those improvements continued even after they stopped using the machines, as though the robot had catalysed further recovery in the weeks after it had been taken away. It even worked for patients who had suffered their stroke some years earlier.
Quotes from users involved in early trials of the device show the impact it is already having on their lives:
- “I am zipping up my coat using both hands, which I could not do before.”
- “I am using the weak arm more in daily activities including washing up, peeling potatoes, carrying things and squeezing toothpaste.”
- “The device has motivated me to do more exercises.”
- “The device gave me a sense of purpose in life, something I looked forward to every day when I got up.”
This success has fired the ambition of the team to make the therapy more widely available and their plan now is to build a fleet of at least ten devices to progress to a full-scale clinical trial, through which they can prove that MyPAM is delivering real benefit – and would pave the way for the device to be manufactured and used as part of patients’ treatment both through the NHS and further afield.
At present MyPAM costs around £5,000 each – which includes the robot arm, a computer and the official certification needed to show it is safe to be used as a medical device.
Donors to the University’s Footsteps Fund contributed more than £82,000 to an appeal to support this research. Read more.
CLICK ON THE LINKS AND VIDEOS BELOW TO READ MORE ABOUT THE IMPACT OF THIS WORK
What is a stroke?
Footsteps Fund support
Project leader Martin Levesley tells how a meeting with a colleague from the Faculty of Medicine sparked research into the use of robotics to help stroke patients to recover.