While much of the world and media focus on how robotics are going to change the landscape of their home, work, or daily commute, a segment of robotics continues to make strides in improving the quality of life for patients who have suffered strokes and other neurological conditions.

Three companies within the space, BIONIK Laboratories Corp., Ekso Bionics, and Corindus Vascular Robotics have made recent announcements to further develop products and technologies around the use of robotics for rehabilitative purposes or treatment of stroke-related conditions.

In late December 2018, BIONIK and Kindred Hospital Rehabilitation Services announced a multi-year agreement that would deploy BIONIK InMotion robots to existing inpatient rehabilitation hospitals and similar facilities across the U.S. A second phase would include installations in new Kindred rehabilitation hospitals over the next four years.

“We are thrilled to enter into this agreement with BIONIK and to bring their world-class rehabilitation technology to patients across the country,” said Russ Bailey, COO and senior vice president of operations at Kindred. “We are truly looking forward to bringing this innovative brand of neurotherapy to our facilities.”

Gentle assistance from robot

Based on therapy and principles of motor learning and neuro-plasticity developed more than 28 years ago, the InMotion Arm therapy guides patients through specific tasks, aiming to improve motor control of the arm by increasing their strength, range of motion and coordination, BIONIK said. Artificial intelligence can help measure the speed and acceleration of the upper limb, and the robot helps assist the patient as needed.

“If the patient can only do 1% of the movement, the robot will do 99%, and then the patient will progress, and less and less the robot will assist,” said Dr. Erik Dusseux, CEO and director of BIONIK, in an interview with Robotics Business Review. “The robot can even be put into resistive mode, and amplify the deviation so the patient improves more and more. It’s really adapting to the needs of the patient.”

BIONIK calls this neurorehabilitation therapy “Assistance as Needed”, where the arm can quietly monitor a patient’s movements during therapy while it gently assists where needed, to help them complete motor therapy activities. Dusseux said when he was doing conventional therapy with patients more than 25 years ago, it was considered great to have patients do 30 to 50 movements per hour. With the robot, patients can achieve a minimum of 600 movements per hour, providing huge benefits over conventional therapy or intensive therapy without robotics, he said.

“It’s this gentle interaction between humans and the robots,” Dusseux said. “You’re succeeding as a patient, you’re succeeding 600 times an hour without you noticing that the robot is helping you, it’s really a very gentle and soft and progressive support that you get from the robot.”

In addition to stroke patients, the system can be effective for patients with Cerebral Palsy, spinal cord injuries, Multiple Sclerosis, Parkinson’s Disease, hemiplegic shoulder pain, and muscle spasticity, BIONIK said. In addition to the arm device, the company has robotics-based devices for the hand and wrist.

Dusseux said this approach has been peer-reviewed more than 60 times by different publications, “which is very unusual for a small company like ours to have that wealth of publications and evidence-based research.”

In addition, the artificial intelligence and machine learning systems with the robots provide a wealth of data to hospitals and therapists to help track patients’ progress before, during, and after therapy sessions.

“Knowing the wealth of data that is measured – the robot knows exactly what the position, speed, and acceleration is, the energy produced, what kind of support it had to provide, and it can measure before and each therapy session, before and after discharge, to show the progress of the patient,” Dusseux said. With more hospitals and rehabilitation centers being asked to demonstrate the quality of care and positive outcomes to patients, this kind of data is valuable for healthcare companies.

He added the company is thrilled to be working with Kindred in getting the devices into additional rehabilitation locations across the U.S. and around the world.

“This is a tremendous opportunity for us to demonstrate the impact of our technology on a broader scale, and to further penetrate the U.S. healthcare and rehabilitation market while generating immediate revenue for BIONIK,” he said. “We are excited about entering this new relationship and to bring our industry-leading therapeutic robotic technologies to Kindred facilities across the country.”

EKSO Bionics’ joint venture in China

Another company that uses robotics in stroke therapy is EKSO Bionics, creator of the EksoGT system designed to help stroke patients relearn to correctly stand and walk after a stroke. Last month, the company announced a $100 million joint venture with two partners to establish a joint venture in China to support the Asian market for rehabilitative centers and to create a global exoskeleton manufacturing center.

Stroke is the leading cause of death in China, with about 2 million people dying of stroke-related illnesses each year, Ekso said. With about 12 million stroke patients currently, the number of patients is expected to reach 30 million by 2030.

“China has a fairly significant challenge in front of them in terms of an aging population, and an unmet need for rehabilitative care,” said Jack Peurach, president and CEO of Ekso Bionics. “There’s also not a really great infrastructure of rehabilitation like we have here in the U.S. With more than 2 million stroke patients each year, but a lot less access to care, we view this as a really big market opportunity to provide more advanced rehabilitative techniques as they develop their rehabilitative infrastructure.”

Peurach said in an interview with Robotics Business Review that the right way to enter this market was through the right partnerships, and the company feels that the two partners (Zhejiang Youchuang Venture Capital Investment Co. and Zhejiang Silicon Paradise Asset Management Group) are the right fit. Ekso will license its manufacturing technology and contribute its relevant Chinese patent rights to the joint venture in exchange for 20% ownership, with the other partners committing $90 million in cash, the company said.

In addition to gaining access to the Chinese market, the company said the joint venture will expand revenue opportunities while providing economics of scale that would allow it to expand into other developing markets. The joint venture’s manufacturing facility will be purpose-built to manufacture the component parts of Ekso Bionics’ products at scale.

“This joint venture is a transformative opportunity both for Ekso Bionics and for the millions of Chinese stroke and spinal cord injury patients who currently have limited access to advanced rehabilitation technologies,” said Peurach.

Robots for neurovascular intervention

Beyond stroke therapy, surgical robotics are being developed to assist with stroke treatment, especially for patients living in more remote locations. Corindus Vascular Robotics recently announced it was seeking premarket clearance from the U.S. Food and Drug Administration (FDA) to use its CorPath GRX System in neurovascular intervention. The system received FDA clearance for percutaneous coronary intervention (PCI, also known as coronary angioplasty) in 2016 and peripheral vascular intervention (PVI, which treats peripheral artery disease) in 2018.

Neurovascular intervention refers to the diagnosis, treatment, rehabilitation, and prevention of vascular disorders that affect the central nervous system with minimally invasive technologies or procedures, Corindus said. The company made software modifications to the CorPath GRX and single-use, additional accessories in order to accommodate the tools, pending the FDA clearance for use in neurovascular applications, it added.

“An expansion of CorPath GRX to treat neurovascular conditions would represent a major stepping stone towards our goal of revolutionizing stroke treatment,” said Mark Toland, president and CEO of Corindus. “We believe that our current robotic platform will bring benefits to neurovascular procedures today and we will leverage our recent achievements in telerobotics and strong focus on technology development to build a remote stroke solution to tackle the challenge of access to care.”

The CorPath GRX System provides assistance for physicians, staff, and patients during interventional procedures, where precise device and stent positioning is needed, the company said. The vascular procedure system provides robotic-assisted control of catheters, guidewires, and rapid exchange catheters, robotic precision, and improved workflow and radiation protection for physicians.

The company recently announced that the CorPath technology was used in the first-in-human Telerobotic Intervention Study, in India. The world’s first PCI procedure was conducted from a remote location outside of the catherization lab, where five patients located at the Apex Heart Institute in Ahmedabad, Gujarat, underwent an elective PCI procedure from about 20 miles away.

Because time is critical for patients suffering from a stroke, remote teleoperation can be a valuable application for many doctors, the company said.

Dr. Aquilla Turk, chief medical officer at Corindus, is spearheading clinical initiatives for the NVI program, including establishing dedicated neurovascular programs to expand robotic treatment, extending the advanced robotic capabilities across the spectrum of vascular interventions, the company said.

“The ability to treat neurovascular disease with CorPath GRX is the first step for physicians to gain critical experience with robotics,” said Dr. Turk. “Applying the benefits of robotic precision to neurovascular intervention, while building a wealth of clinical knowledge and expertise, are key to preparing for a future of remote stroke treatment.”