Robotics and Clinical Research: Collaborating to Expand the Evidence Base for Rehabilitation

INTRODUCTION Advances in robotic technology have led to an important crossroad regarding their applications to physical and rehabilitation medicine. One aspect of this crossroad is healthcare providers' and the general public's continuing eagerness to use "robotics" to enhance clinical and patient care. Body-weight support treadmill systems, bionic neurons (BIONs[TM]), KineAssist[TM], and the Massachusetts Institute of Technology (MIT)-Manus are visible examples of robots that can help improve many patients' function, mobility, and overall quality of life [1-5]. The other aspect of this crossroad is clinicians' and researchers' recognition that systematically implementing these promising technologies in treatment and rehabilitation regimens requires a greater scientific base of evidence [6-7]. The biomedical, rehabilitation, biomedical engineering, and behavioral sciences continuously add to our understanding of how robotics can be used in rehabilitation. Yet several questions regarding design, man-machine interface, biological/physiological mechanisms, and treatment parameters still remain. Furthermore, more rigorous clinical trials are particularly needed for providing definitive scientific evidence for clinical guidelines [8]. Recent efforts sponsored by the Department of Veterans Affairs (VA) Office of Research and Development (ORD) are helping to fill these gaps. The Veterans Health Administration (VHA), as the largest integrated healthcare system in the United States, funds a major intramural research program specifically intended to improve veterans' health and healthcare. ORD-sponsored activities range from preclinical research to multisite clinical trials to studies for determining how to best implement research findings. These activities are overseen by four research services: the Biomedical Laboratory Research and Development (R&D) Service, the Clinical Science R&D Service, the Health Services R&D Service, and the Rehabilitation R&D Service. Although certain types of research may better characterize the purview of a particular service, the multidisciplinary nature of key clinical questions requires that these services jointly pursue innovative, comprehensive investigations to advance the VA research mission of total healthcare for veterans. In this guest editorial, we provide an overview of VA robotics-related research and give a specific example of how the VA has bridged its clinical trials expertise with neurorehabilitation experts in a novel trial that uses robots for stroke rehabilitation. We highlight these studies to demonstrate how collaborative clinical research efforts are helping to build the scientific evidence base for the use of robotics in state-of-the-art care for our veterans. DEPARTMENT OF VETERANS AFFAIRS ROBOT-BASED STUDIES VA-supported robot-based investigations aimed at rehabilitative applications primarily stem from the Rehabilitation R&D Service. Several of these efforts are based at seven national Centers of Excellence (COEs) that are dedicated to the development, application, and broad dissemination of emerging technologies that restore and augment impaired function. Engineers and clinician scientists at the Cleveland Functional Electrical Stimulation Center have developed technological solutions to neurological and muscular skeletal impairments. Clinician scientists at the Baltimore VA Medical Center (VAMC) recently established a COE on Task-Oriented Exercise and Robotics in Neurological Diseases to study conditions such as Parkinson's disease and multiple sclerosis. The Boston COE for Visual Innovation is one of a handful of research teams around the world dedicated to retinal prosthesis development. Preliminary findings show restoration of functional sight in patients who had been blind for more than 40 years. The Pittsburgh COE on Wheelchairs and Associated Technology develops mobility aids and performs associated research necessary for evidence-based practices and prescription guidelines for improving quality of life. …