by Ruggiero Corcella
Digital mirrors, 3D cameras, apps and telemedicine are also revolutionizing this branch of medicine. Without canceling traditional rehabilitation
Have you ever seen yourself running or engaged in some exercise? It seems trivial, but being able to observe your posture during a sporting activity helps you understand how you are doing it and therefore change any incorrect settings. And what if this “look” was provided by artificial intelligence, complete with real-time data on movement, posture, joint degrees, strength, foot support, gait and running patterns?
The experience becomes much more exciting – and fun – as well as “scientific”. Because in this way a patient who has to undergo rehabilitation therapy, for example, understands better and immediately whether he is carrying out the instructions received in the right way and has immediate and objective feedback on the progress (or even “steps backwards”) made.
Patient takes an active part in the treatment
This is the “futuristic” setting of the new Hi-Tech Rehabilitation Center & Sport Lab at Humanitas Medical Care in Bergamo. An innovative space in the field of rehabilitation that uses sophisticated technological equipment based on artificial intelligence to evaluate, analyze and improve the physical recovery of people with musculoskeletal or joint problems, also due to surgical interventions, and of athletes through individualized rehabilitation and physiotherapy programmes.
«The patient becomes an active part – underlines Michele Albano, physiatrist, head of Rehabilitation at Humanitas Gavazzeni and Medical Care Bergamo -. He increases his participation in therapy because he has greater awareness and notices improvements or any slowdowns in the rehabilitation process. Therefore there is a greater predisposition to undertake this path with new technology, a path which with traditional therapy can often be boring because, depending on the pathology to be treated, it involves sessions lasting an hour, an hour and a half, very repetitive with results that are sometimes very slow and with suffering related to pain and with results that are difficult to measure objectively. Let’s try to think what it means to re-educate a cruciate ligament in the summer with heat, humidity and sweat…”.
For which disorders and pathologies is it suitable?
In particular, in the Hi-Tech Rehabilitation Center & Sport Lab the experts prepare personalized treatments for various disorders and pathologies such as, for example: joint trauma; tendon, muscle and ligament injuries; fractures; dislocations; arthrosis; backache; muscle or joint pain; post-surgery rehabilitation (e.g. hip and knee, shoulder, anterior cruciate ligament); pre-operative rehabilitation.
«The idea was born precisely to provide services from a rehabilitation point of view that can be decidedly more precise and thus obtain fundamental results in the clinical field – clarifies Albano -. However, this will not subvert or cancel traditional rehabilitation, which remains fundamental. Because, especially in the acute phase, therefore in the post-operative period, the physiotherapist, under the control of the physiatrist, must manage the pain and recover movement”.
«Let’s imagine a hip replacement operation: after the operation, the patient is put on his feet on the first day. But he still does not have the autonomy and independence necessary to walk and at the same time he also has an altered motor pattern, poor muscle tone and sometimes pain that limit him. Therefore the first phase will include the same type of treatments, with manual and instrumental therapy. Subsequently, the patient will be able to carry out rehabilitation treatments within these new spaces to re-adapt to autonomy, to the function of the joint and then possibly also to the sporting gesture”, he adds.
There is always the supervision of a doctor
The Bergamo structure is a concentration of technologies, but always under the supervision of the team of physiotherapists dedicated to medical rehabilitation and sports performance. The machines have been used in scientific studies, especially in the neurological field (Parkinson’s, stroke) and in prosthetics (hip and knee). Then also in the evaluation of posture and for stabilometry. «These equipment can be used in the medical field as we do, or by a personal trainer and therefore inside a gym, dealing only with re-education in sporting gestures», underlines the physiatrist.
Digital mirrors, 3D cameras, smart treadmills
There are seven technologies supplied to the Centre, with different functions.
1) Assessment of posture, balance and strength
A hi-tech digital mirror allows you to perform every motor gesture for posture, balance and strength, analyzing the movement in real time according to parameters. Through a 3D camera and a force platform, the machine recognizes in real time up to 16 joints of the body and every movement made in the operating area.
2) Evaluation of balance
Another machine “measures” the balance of patients and athletes in the orthopedic field or recovering from injuries through the mechanical system and the 50-level electronic stability control connected to the software.
3) Evaluation of posture in movement, load of the lower limbs during walking and running
A treadmill analyzes walking in a complete way: through a 3D camera the person placed in front of it on the belt is filmed, so as to return an instantaneous image based on data of the dynamic posture in movement.
4) Motor rehabilitation with weight relief
This technology is combined with a weight “neutralization” system which allows the person’s post-operative recovery times to be reduced by evaluating the evolution of the treatment on the basis of data.
5) Analysis of walking and running
Another treadmill equipped with a 3D camera recognizes the movement of the joints and displays, in real time on the screen, the posture parameters according to set movements.
6) Central pelvic floor reinforcement, lumbar stabilization
The device allows you to give indications on the quantity and quality of the perception of pelvic movement.
7) Back problems, lumbar, dorsal, cervical pain, improvement of postural structure
Finally, with a special postural bench it is possible, using electronic inclinometers, to carry out an accurate postural analysis without load on the limbs and, at the same time, improve the person’s posture by reducing, even eliminating, tension and pain.
How to access the Center
In addition to patients who come from the Humanitas hospital circuit and therefore follow an internal path, to access the Center it is necessary to carry out a medical-physiatric examination in the presence of orthopedic pathologies and/or surgical interventions, which is not necessary if you enter for evaluation or for useful paths for sports improvement. The rehabilitation plan, in addition to the use of machinery equipped with the latest generation technologies, can also include the use of manual therapies, individual muscle strengthening exercises and traditional instrumental therapies (tecartherapy, magnetotherapy, antalgic laser therapy, ultrasound therapy, transcutaneous electroanalgesia tens , pressotherapy, ozone therapy, localized cryotherapy).
As regards the individual sports path, the Center has various programs for improving the state of health and enhancing sports performance (health, fitness, sports performance, runner, over 50s, balance, walking, strength). All of this is currently paid because the National Health Service does not yet recognize this type of “innovative” rehabilitation.
Data privacy
What happens to the data collected during the sessions? « As for access to facilities, visits or exams, the patient will sign a consent for the use of the data, subject to all the necessary safeguards which in any case always remains within our servers – replies Albano -. The doctor or physiotherapist in charge of the treatments is the only one who can access that data. The patient is supplied with a USB stick, which allows him to access only his own data. With this key you only activate your “user profile”, with the related exercise programs to do with the machines here at the Centre. But not only”.
Telemedicine
In fact, soon there will also be the possibility of carrying out the exercises comfortably at home «through a portable device equipped with a 3D camera – explains Albano – which can be connected to the smartphone, or to a PC, tablet or smart TV via wifi or bluetooth or with a HDMI cable. The preloaded software has a whole host of rehabilitation programs. The physiotherapist sets the ones necessary for the patient and can then follow him, both live and deferred. Any type of rehabilitation protocol is always recorded within that flash drive and an app that the patient can download onto their phone, so the physiotherapist can then remotely, via the servers, evaluate the exercises”.
Experimental studies still too limited
Today, robots for rehabilitation, exoskeletons for assistance, upper and lower limb prostheses, wearable sensors and artificial intelligence algorithms for communication and interaction with machines, augmented and virtual reality systems for facilitate interaction with technology are the subject of advanced research but are still used in individual centers within small experimental studies which offer the first encouraging results but do not allow the clinical effectiveness of these technologies to be systematically analysed.
An obstacle that the project «Fit For Medical Robotics» – led by the National Research Council (CNR) with the Campus Bio-Medico University of Rome and the Don Gnocchi Foundation – is trying to overcome with the final objective of scientifically demonstrating what is the most effective use of robotic technology within of the patient’s rehabilitation process, with the same precision with which today we are able to prescribe a drug.
For the first time in Italy, research on advanced technologies for rehabilitation and treatment synergistically connects engineers and clinicians within more than 50 different studies with over 2,000 patients involved in more than 25 facilities throughout Italy. The clinical and research centers and the companies involved operate together thanks to funding of 126 million euros made available as part of the Complementary Plan to the PNRR by the Ministry of University and Research.
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February 9, 2024 (modified February 9, 2024 | 07:44)
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