Scientific robotics. Robots in Medicine: A Review of Modern Technologies Robotic Medicine

Today, research groups around the world are trying to grope for the concept of using robots in medicine. Although it is more correct, perhaps, to say "already groped." Judging by the number of developments and the interest of various scientific groups, it can be argued that the creation of medical microrobots has become the main direction. This also includes robots with the prefix "nano-". Moreover, the first successes in this area were achieved relatively recently, only eight years ago.

In 2006, a team of researchers led by Sylvain Martel conducted the world's first successful experiment by launching a tiny robot the size of a fountain pen ball into the carotid artery of a live pig. At the same time, the robot moved along all the “way points” assigned to it. And over the years that have passed since then, microrobotics has advanced somewhat.

One of the main goals for engineers today is to create such medical robots that will be able to move not only through large arteries, but also through relatively narrow blood vessels. This would allow complex treatments to be carried out without such a traumatic surgical intervention.

But this is far from the only potential benefit of microrobots. First of all, they would be useful in the treatment of cancer by delivering the drug directly to the malignancy in a targeted manner. It is difficult to overestimate the value of this opportunity: during chemotherapy, drugs are delivered through a dropper, causing a severe blow to the entire body. In fact, it is a strong poison that damages many internal organs and, for company, the tumor itself. This is comparable to carpet bombing to destroy a small single target.

The task of creating such microrobots is at the intersection of a number of scientific disciplines. For example, from the point of view of physics - how to make such a small object move independently in a viscous liquid, which for it is blood? From the point of view of engineering - how to provide the robot with energy and how to track the movement of a tiny object through the body? From the point of view of biology - what materials to use for the manufacture of robots so that they do not harm the human body? And ideally, robots should be biodegradable so that they do not have to solve the problem of their removal from the body.

One example of how microrobots can "contaminate" a patient's body is a "bio-rocket".

This version of the microrobot is a titanium core surrounded by an aluminum shell. The robot diameter is 20 µm. Aluminum reacts with water, during which hydrogen bubbles form on the surface of the shell, which push the entire structure. In water, such a “bio-rocket” swims in one second a distance equal to 150 of its diameters. This can be compared to a two-meter tall man who swims 300 meters in a second, 12 pools. Such a chemical engine works for about 5 minutes due to the addition of gallium, which reduces the intensity of the formation of an oxide film. That is, the maximum power reserve is about 900 mm in water. The direction of movement is given to the robot by an external magnetic field, and it can be used for targeted drug delivery. But only after the “charge” runs out, the patient will find a scattering of microballoons with an aluminum shell, which does not have a beneficial effect on the human body, unlike biologically neutral titanium.

Microrobots must be so small that simply scaling traditional technologies to the right size will not work. No standard parts of a suitable size are also produced. And even if they did, they simply would not be suitable for such specific needs. And therefore, researchers, as it has happened many times in the history of inventions, are looking for inspiration from nature. For example, in the same bacteria. At the micro, and even more so at the nanolevel, completely different physical laws operate. In particular, water is a very viscous liquid. Therefore, other engineering solutions to ensure the movement of microrobots. Bacteria often solve this problem with the help of cilia.

Earlier this year, a team of researchers from the University of Toronto created a prototype microrobot 1 mm long, controlled by an external magnetic field and equipped with two grippers. The developers managed to build a bridge with it. Also, this robot can be used not only for drug delivery, but also for mechanical tissue repair in the circulatory system and organs.

Muscular robots

Another interesting trend in microrobotics is muscle-driven robots. For example, there is such a project: stimulated by electricity muscle cell, to which a robot is attached, whose "ridge" is made of hydrogel.

This system, in fact, copies the natural solution found in the organisms of many mammals. For example, in the human body, muscle contraction is transmitted to the bones through the tendons. In this biorobot, when the cell contracts under the action of electricity, the “ridge” bends and the cross bars, which act as legs, are attracted to each other. If one of them, when bending the “ridge”, moves a shorter distance, then the robot moves towards this “leg”.

There is another vision of what medical microrobots should be: soft, repeating the forms of various living beings. For example, here is such a robo-bee (RoboBee).

True, it is not intended for medical purposes, but for a number of others: pollination of plants, search and rescue operations, detection of toxic substances. The authors of the project, of course, do not copy blindly anatomical features bees. Instead, they carefully analyze the various "constructions" of the organisms of various insects, adapting and translating them into mechanics.

Or another example of the use of "constructions" available in nature - a microrobot in the form of a bivalve mollusk. It moves with the help of slamming "shutters", thereby creating a jet stream. With a size of about 1 mm, it can swim inside a human eyeball. Like most other medical robots, this "clam" uses an external magnetic field as a power source. But there is an important difference - it only receives energy for movement, the field itself does not move it, unlike most other types of microrobots.

big robots

Of course, only microrobots park medical technology is not limited. In fantasy films and books, medical robots are usually presented as a replacement for a human surgeon. Like, this is a kind of large device that quickly and very accurately performs all kinds of surgical manipulations. And it is not surprising that this idea was one of the first to be implemented. Of course, modern surgical robots are not able to replace a person as a whole, but they are already completely trusted with stitching. They are also used as extensions of the surgeon's hands, like manipulators.

However, in the medical environment, disputes regarding the appropriateness of using such machines do not subside. Many experts are of the opinion that such robots do not provide special benefits, but due to their high price, they significantly increase the cost of medical services. On the other hand, there is a study according to which patients with prostate cancer undergoing surgery with a robotic assistant require less intensive use in the future. hormonal drugs and radiotherapy. In general, it is not surprising that the efforts of many scientists were directed to the creation of microrobots.

An interesting project is Robonaut, a telemedicine robot designed to assist astronauts. This is still an experimental project, but this approach can be used not only to provide such important and expensive people in training as astronauts. Telemedicine robots can also be used to provide assistance in various hard-to-reach areas. Of course, this would only be advisable if it would be cheaper to install a robot in the infirmary of some remote taiga or mountain village than to keep a paramedic on a salary.

And this medical robot is even more highly specialized, it is used to treat baldness. ARTAS automatically “digs out” hair follicles from the patient's scalp based on high-resolution photographs. Then the human doctor manually introduces the "harvest" into the bald areas.

Still, the world of medical robots is not at all as monotonous as it might seem to an inexperienced person. Moreover, it is actively developing, there is an accumulation of ideas, experimental results, and the most effective approaches are being sought. And who knows, perhaps even during our lifetime the word “surgeon” will mean a doctor not with a scalpel, but with a jar of microrobots, which will be enough to swallow or introduce through a dropper.

". Translation into Russian editorial site

2.3 Medicine and robotics

2.3.1 Area overview

Healthcare and robots

As a result of demographic changes in many countries, health care systems are facing increasing pressure as they have to serve an aging population. As the demand for services grows, procedures are being improved, leading to better results. At the same time, the cost of providing medical services, despite the decline in the number of people employed in the field of medical care.

The application of technology, including robotics, appears to be part of a possible solution. In this document, the field of medicine is divided into three sub-areas:

- Robots for hospitals (Clinical Robotics): You can define the corresponding robotic systems as those that provide the processes of "care" and "healing". First of all, these are robots for diagnostics, treatment, surgical intervention and administration of medicines, as well as in emergency systems. These robots are operated by hospital staff or trained patient care professionals.

- Robots for rehabilitation (Rehabilitation): Such robots provide post-operative or post-traumatic care when direct physical interaction with the robotic system will either speed up the process of recovery (recovery) or provide replacement for lost functionality (for example, when it comes to a prosthetic leg or arm).

- Auxiliary robots (Assistive robotics): This segment includes other aspects of robotics used in medical practice, when the primary purpose of robotic systems is to provide support either to the one who provides medical care or directly to the patient, regardless of whether it is a hospital or other medical institution.

All of these subdomains are characterized by the need to provide security systems that take into account the clinical needs of patients. Typically, these systems are managed or configured by qualified hospital personnel.

Medical robotics is more than just a technology

In addition to the development of directly robotic technologies, it is important that appropriate robots are introduced as part of the processes of treatment in a hospital or other medical procedures. System requirements should be based on clearly identified needs of the user and service recipient. When developing such systems, it is critical to demonstrate the added value they can provide when implemented, which is critical to continued success in the marketplace. Getting added value requires the direct involvement of medical professionals, as well as patients, in the development process of this technique, both at the design and implementation stages of robot development. The development of systems in the context of their future application environment ensures that stakeholders are involved. A clear understanding of existing medical practice, the obvious need to train medical personnel to use the system, and possession of various information that may be required for development are critical factors in creating a system suitable for further implementation. Introduction of robots in medical practice will require adaptation of the entire system of health care delivery. This is a delicate process in which technology and practice in healthcare delivery are mutually influenced and will have to adapt to each other. From the start of development, it is important to take this aspect of "interdependence" into account.

The development of robots for the needs of medicine includes a very wide range of different potential applications. Let's consider them below, in the context of the previously identified three main market segments.

Robots for hospitals

This segment is represented by a variety of applications. For example, the following categories can be distinguished:

Systems that directly enhance the surgeon's capabilities in terms of dexterity (flexibility and precision) and strength;

Systems that allow remote diagnostics and interventions. This category can include both teleoperated systems, when the doctor can be at a greater or lesser distance from the patient, and systems for use inside the patient's body;

Systems that provide support during diagnostic procedures;

Systems that provide support during surgical procedures.

In addition to these hospital applications, there are a number of hospital ancillary applications, including sampling robots, laboratory testing of tissue samples, and other services needed in hospital practice.

Robots for rehabilitation

Rehabilitation robotics includes devices such as prostheses or, for example, robotic exoskeletons or orthoses that provide training, support, or replacement for lost activities or impaired functionality. human body and its structures. Such devices can be used both in hospitals and in Everyday life patients, but usually require initial setup by medical professionals and subsequent monitoring of their correct operation and interaction with the patient. Postoperative recovery, especially in orthopedics, is predicted to be a major application for such robots.

Specialist support and assistive robotics

This segment includes assistive robots for use in hospitals or in the home environment that are designed to help hospital staff or caregivers perform routine tasks. It can be noted a significant difference in the design and implementation of robotic systems associated with the place and conditions of their use. In the context of skilled use, whether in a hospital environment or at home when using a robot to care for an elderly person, developers can rely on a qualified person to operate the robot. Such a robot must meet the requirements and standards of the hospital and healthcare system and have the appropriate certificates. These robots will assist the staff of the respective medical institutions in their daily work, especially nurses and carers. Such robotic systems should allow the nurse to spend more time with patients, reducing physical stress, for example, the robot will be able to lift the patient in order to carry out the necessary routine operations with him.

2.3.2 Opportunities now and in the future

Robotics for medicine is an extremely complex field of development due to its multidisciplinary nature and the need to comply with various stringent requirements, as well as the fact that in many cases medical robotic systems physically interact with people who can also be in a very vulnerable state. . Here are the main opportunities that exist in the segments of medicine we have identified.

2.3.2.1 Hospital robots

These are robots for surgery, diagnostics and therapy. The market for surgical robots is large in size. Robotic-assistive capabilities can be used in almost all areas - cardiology, vascular, orthopedics, oncology and neurology.

On the other hand, there are many technical challenges related to size limitations, environmental constraints, and the small number of technologies that are available for immediate use in a hospital setting.

In addition to technological problems, there are also commercial ones. For example, related to the fact that the United States is trying to maintain a monopoly position in this market due to the volume of intellectual property. This situation can be circumvented only by developing fundamentally new hardware, software and control concepts. Also, such developments require solid financial support for high-cost, but necessary developments and related clinical trials. Typical areas where opportunities currently exist:

Minimally Invasive Surgery (MIS)

Success can be achieved here by developing systems that can expand the flexibility of instrument movements beyond the limits of the anatomy of the surgeon's hands, increase efficiency, or supplement the systems with feedback (for example, to judge the force of pressure), or additional data to help the procedure. Successful market penetration may depend on the cost effectiveness of the product, reduced deployment time, and reduced additional training required to learn how to use the robotic system. Any system developed must clearly demonstrate the "added value" in the context of surgery. Clinical pilot implementations and evaluations during such testing in clinics are essential for the system to be accepted by the surgical community.

Compared to other areas of minimally invasive surgery, assistive robotic systems have the potential to provide the surgeon with better control of surgical instruments, as well as better visibility during surgery. The surgeon is no longer required to stand during the entire operation, so he does not tire as quickly as with the traditional approach. Hand tremor can be almost completely filtered out by the robot software, which is especially important for applications in microscale surgery such as eye surgery. In theory, a surgical robot can be used almost 24 hours a day, replacing the surgical teams that work with it.

Robotics can provide rapid recovery, injury reduction and reduced negative impact on the patient's tissue, as well as reducing the required radiation dose. Robotic surgical instruments can offload the doctor's brain, shorten the learning curve, and improve workflow ergonomics for the surgeon. Therapies that are constrained by the limits of the human body are also becoming possible with the transition to the use of robotic technologies. For example, a new generation of flexible robots and tools that can reach organs deep within the human body, reduce the size of the entry incision in the human body, or dispense with natural openings in the human body to perform surgical operations.

In the long term, the use of learning systems in surgery can reduce the complexity of the operation by increasing the flow useful information which the surgeon will receive during the operation. Other potential benefits include the ability to enhance the capabilities of paramedical ("ambulance") teams in robot-assisted standard clinical emergency procedures in field conditions, as well as performing tele-surgical operations at remote sites, where there is only an appropriate robot and there is no qualified surgeon.

The following possibilities can be distinguished:

New compatible tools that provide increased security while retaining full manipulation capabilities, including rigid tools. Through the use of new control methods or special solutions (which, for example, may be built into the instrument or external to it), the functioning of the instruments can be adjusted in real time so as to ensure compatibility or stability, when what is more important;

The introduction of improved assistive technologies that guide and warn the surgeon during the operation, which allows us to talk about simplifying the solution of surgical tasks and reducing the number of medical errors. This "training support" should increase the "compatibility" of the equipment and the surgeon, which will ensure intuitiveness and no doubts when using the system.

Applying appropriate levels of robot autonomy in surgical practice up to the complete autonomy of specific well-determined procedures, for example: autonomous autopsy; taking blood samples (Veebot); biopsy; automation of part of the surgical procedures (tightening knots, supporting the camera...). Increasing autonomy has the potential to increase efficiency.

- "Smart" surgical instruments are essentially conditionally controlled by surgeons. These instruments are in direct contact with the tissue and enhance the surgeon's skill level. Miniaturization and simplification of surgical instruments in the future, as well as the availability of surgical procedures inside and outside the "operating theater" is the main way to develop such technologies.

Education: Providing physically accurate models, which is achieved through the use of tools with tactile feedback, provides the potential for improving learning, both in the early stages of learning, and when achieving confident work skills. The ability to simulate a wide variety of conditions and complexities can also increase the effectiveness of this type of learning. Currently, the quality of tactile feedback still contains a number of limitations, which makes it difficult to demonstrate the superiority of this type of learning.

Clinical Samples: There are many applications for offline sampling systems, from systems for taking blood samples and tissue samples for biopsy to less invasive autopsy techniques.

2.3.2.2 Robotics for rehabilitation and prosthetics

Rehabilitation robotics covers a wide range various forms rehabilitation and can be divided into sub-segments. In Europe, there is a fairly strong industry in this sector and active interaction with it will accelerate technological development.

Means of rehabilitation

These are products that can be used after an injury or after surgery to train and support recovery. The role of these tools is to support recovery and accelerate recovery, while protecting and supporting the user. Such systems can be used in a hospital environment under the supervision of medical staff or can be used as a stand-alone exercise, with the device controlling or restricting movement, as required in the particular case. Such systems can also provide valuable data on the recovery process and monitor the condition more directly than even when observing a patient in a hospital setting.

Functional Replacement Tools

The purpose of such a robotic system is to replace the lost functionality. This may be the result of aging or traumatic injury. Such devices are being developed to improve the mobility and motor skills of the patient. They can be performed as prostheses, exoskeletons or orthopedic devices.

In advanced rehabilitation systems, it is critical that existing European manufacturers are involved in the process as well-known market participants, and relevant clinics and clinic partners are involved in the development process. Europe currently leads the world in this area.

Neuro rehabilitation

(The COST Network TD1006, the European Network for Robotics for Neuro-Rehabilitation provides a platform for the exchange of standardized definitions and development examples across Europe).

Few robotic neuro-rehabilitation devices are currently in use, as they have not yet been widely adopted. Robotics is used for post-stroke rehabilitation in the post-acute phase and other neuro-motor pathologies such as Parkinson's disease, multiple sclerosis and ataxia. Positive results with the use of robots (no worse or better than with traditional therapy) for rehabilitation purposes are beginning to be confirmed by research results. Recently, positive results have also been confirmed by neuroimaging research. It has been proven that integration with FES showed an increase in the positive result (both for the muscular system, and for the peripheral and for the central motor system). Biofeedback exercises and game interfaces are beginning to be seen as solutions that can be implemented, but such systems are still at an early stage of development.

In order to develop workable systems, several problems must be solved. These are low cost devices, proven results of clinical trials, a well-defined process for assessing the patient's condition. The ability of systems to correctly identify user intent and thereby prevent injury currently limits the effectiveness of such systems. Control and mechatronics integrated to meet the capabilities of the human body, including cognitive load, are in the early stages of development. Improvements in reliability and uptime must be made before commercially viable systems can be developed. Also, development goals should be fast deployment time and demand by therapists.

Prosthetics

Significant progress can be made in the field of the production of smart prostheses that are able to adapt to the characteristics of the user's movements and to environmental conditions. Robotics has the potential to combine improved self-learning capabilities with increased flexibility and control, especially for prostheses. upper limbs and wrist prostheses. Particular areas of research include the ability to adapt to personal, semi-autonomous control, provision of artificial sensitivity through feedback, improved verification, improved energy efficiency, self power recovery, improved processing of myoelectric signals. Smart prostheses and orthoses, controlled by the activity of the patient's muscles, will allow a large group of users to take advantage of such systems.

Mobility support systems

Patients with reduced physical capacity, whether temporary or permanent, may benefit from increased mobility. Robotic systems can provide the support and exercises needed to increase mobility. There are already examples of the development of such systems, but they are at an early stage of development.

In the future, it is possible that such systems can even compensate for cognitive impairment, preventing falls and accidents. The limitations of such systems are related to their cost, as well as the ability to wear such systems for a long time.

In a number of rehabilitation applications, it is possible to use natural interfaces such as myoelectrics, brain imaging, as well as interfaces based on speech and gestures.

2.3.2.3 Specialist support and assistive robots.

Support from experts and assistive robotics can be divided into a number of areas of application.

Patient Care Support Systems: Support systems used by caregivers who interact with patients or systems used by patients. These may include robotic systems that ensure the use of medicines, take samples, improve hygiene, or improve recovery processes.

Lifting and moving the patient : Patient lifting and positioning systems can range from precise positioning during surgery or radiation therapy sessions to assisting nurses or caregivers in lifting or placing a person in and out of bed, and transporting patients around the hospital. . Such systems can be designed so that they can be configured depending on the condition of the patient and used so that the patient has a certain degree of control over their position. Limitations here may be related to the need to obtain safety certifications and safely manage forces sufficient to move patients in a way that avoids possible injury to patients. Energy efficient structures and space saving design will be critical for efficient implementations.

When developing assistive robotics solutions, it is important to adhere to a set of basic principles. Development should focus on supporting the missing functionality, not on creating specific conditions. Solutions must be practical in terms of their use and provide measurable benefits to the user. This may include using technology to motivate patients to do as much for themselves as possible while maintaining safety. The introduction of such systems will not be viable and in demand if they do not provide an opportunity to reduce the workload on personnel, creating an economic case for implementation, while simultaneously being reliable and safe to use.

Robots for biomedical laboratories for medical research

Robots are already finding their way into biomedical labs, where they sort and manipulate samples for research purposes. Applications for complex robotic systems expand the possibilities even more, for example, in the field of advanced cell screening and manipulations related to cell therapy and selective cell sorting.

2.3.2.4 Requirements in the medium term

The following list represents "growth points" in the field of medical robotics

Lower torso exoskeletons that tailor their function to individual patient behavior and/or anatomy, optimizing support based on user or environmental conditions. Systems can be adapted by the user to different conditions and performance various tasks. Applications: neuro-rehabilitation and worker support.

Robots designed for autonomous rehabilitation (eg, rehabilitation in the "game" mode, rehabilitation of the upper limbs after a stroke) must understand the needs of the patient and his reactions, as well as adjust the therapeutic effect to them.

Robots designed to support patient mobility and manipulation capabilities must support natural interfaces to ensure safety and performance in near-natural environments.

Rehabilitation robots designed to integrate sensors and motors by providing bi-directional communication, including multi-mode command input (myoelectric + inertial sensing) and multi-mode feedback (electro-tactile, vibro-tactile and/or visual).

Prosthetic arms, wrists, hands that automatically adapt to the patient, allowing him to control individually any finger, thumb rotation, carpal DOFs. This should be accompanied by the use of multiple sensors and pattern recognition algorithms to ensure natural control (constant force control) at the expense of possible DOFs. Applications: Restoration of hand functionality for amputees.

Prostheses and rehabilitation robots equipped with semi-automatic control systems to improve the quality of functioning and / or reduce the cognitive load on the user. Systems must allow the perception and interpretation of the environment, up to a certain level, to enable autonomous decision making.

Prostheses and rehabilitation robots capable of using a variety of online resources (information storage, processing) through the use of cloud computing to implement advanced functionality that is significantly beyond the capabilities of "on-board" electronics and / or direct user control.

Inexpensive prostheses and robotic solutions created using additive technologies or mass production (3D printing, etc.)

Home therapy reducing neuropathic or phantom upper limb pain through improved interpretation of muscle signals using robotic limbs (less flexible than previous examples) and/or "virtual reality".

Biomimetric control of interaction with a surgical robot.

Adequate mechanical actuation and sensor technologies for the development of flexible miniature force feedback robots, as well as advanced and advanced minimally invasive surgery instruments.

Environmental charging systems for implantable micro-robots.

To obtain biomimometric management of rehabilitation processes: the integration of volitional "impulses" during the movement of the subject, with the support of FES for improved re-learning of motor skills, when controlling the robot.

Development of hospital-applicable methods for the restoration of motor activity that goes beyond the paradigm of commonly used static mechanisms with manual adjustment.

On a low TRL

Automated cognitive understanding of the necessary tasks in the operating environment. Seamless physical association of a human-robot for the conditions of a "normal" environment based on an additional control interface. Complete, no-adjustment adaptability to the patient. Reliability of detection of intentions.

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Medical robots today and tomorrow

Medicine has always been difficult, today they talk about it as one of the most difficult areas that humanity has mastered. Nevertheless, medical robots can make accurate diagnoses and provide treatment, and very soon they will master other medical areas.

We are born, we live, and in the end we die. This is true. However, our quality of life often correlates with our health. In general, the healthier we are, the more we can achieve - thus, we are happier.

That's why health has always been a problem. Nowadays, medicine has come a very long way compared to the time of Hippocrates Kos. Now people can do very complex operations, invent medicines for various diseases, and so on. The question arises: can medicine go further and how?

The answer to the first part of the question is "definitely". However, the answers to the second part may differ. There are many notable fields that could change the course of the medical history, such as stem cells. However, I am confident that the field of robotics and robotics-related fields such as medical bionics and biomechatronics will play a big role in medicine in the near future.

In fact, there are a lot of interesting things going on in these areas right now. So, in this section of my site, I will try to shed some light on questions about medical robots and the fields related to robotics in medicine, now and in the future.

Operations with the help of a robot

Medical robots that can perform surgeries sound wonderful, don't they? All existing surgical robots to this day are in fact cleverly made by manipulators controlled by competent doctors. There are some problems with the level of artificial intelligence needed to independent work, but this may be achieved one day.

There are currently two fields in which surgical robots are being developed and tested. One of them is a telerobot that allows a doctor to perform an operation from a distance. Another field is minimally invasive surgery - the operation is performed without large cuts.

The da Vinci robotic surgery system is one of the prime examples of the use of robotics for surgical purposes. Over a thousand units are in use worldwide. Learn more about robotic surgery in general.

Robots are the new hospital staff

Hospitals are a bit like factories. There are many mundane tasks. For example - transferring things, moving samples from one apparatus to another, cleaning. There are also tasks that require some strength. For example, lifting and moving patients.

I believe you understand that there are many tasks that medical robots can perform. There have been some developments in this area - there are robots designed for laboratory use, there are AGVs (Automated Guided Vehicle) designed for use in hospitals.

As far as I know, most of them are in the testing phase. However, it is certainly a doable task.

Therapeutic robots

Medical robots used in therapy. The idea behind this is quite similar to animal therapy, only robots are more predictable. Learn more about therapeutic robots.

Biological prosthetics

This is a field related to robotics. The result cannot be considered a robot, but the disciplines included in it are quite similar - AI, electronics, mechanics, and more.

The great dream is that one day there will be bionic arms and bionic legs as good and functional (or even better) than our natural limbs. The recent development in this area is quite striking. Several companies are working in this area - Ossur, Otto Bock and Touch Bionics are some of the ones I know.

Application and use of robots in medicine in the future

Perhaps this will be possible in the future. The idea is to develop devices as small as a few nanometers, hence the name nano-robots. These small devices can then be used in a variety of ways. For example, to fix a broken bone or to deliver medicine to Right place or to kill cancer cells.

The possibilities are only limited by the imagination. By now, nanorobots are in the research and development phase, so this is actually a fantasy.

The second half of the 20th century was a time of intensive development in all areas of science, technology, electronics and robotics. Medicine has become one of the main vectors for the introduction of robots and artificial intelligence. The main goal of the development of medical robotics is high accuracy and quality of service, increasing the effectiveness of treatment, and reducing the risk of harm to human health. Therefore, in this article we will look at new methods of treatment, as well as the use of robots and automated systems in various fields of medicine.

Back in the mid-70s, in the hospital in Fairfax, USA, Virginia, the first medical mobile robot ASM appeared, which transported containers with trays to feed patients. In 1985, for the first time, the world saw the PUMA 650 robotic surgical system, designed specifically for neurosurgery. A little later, surgeons received a new PROBOT manipulator, and in 1992 the RoboDoc system appeared, which was used in orthopedics for joint prosthetics. A year later, Computer Motion Inc. introduced the Aesop automatic arm for holding and repositioning a video camera during laparoscopic procedures. And in 1998, the same manufacturer created a more advanced ZEUS system. Both of these systems were not completely autonomous, their task was to assist doctors during surgery. In the late 90s, the developer company Intuitive Surgical Inc created a universal remote-controlled robotic surgical system - Da Vinci, which is being improved every year and is still being implemented in many medical centers around the world.

Classification of medical robots:

Currently, robots play a huge role in the development of modern medicine. They contribute precision work during operations, they help to diagnose and make the correct diagnosis. They replace missing limbs and organs, restore and improve a person's physical capabilities, reduce hospitalization time, provide convenience, responsiveness and comfort, and save financial costs for maintenance.

There are several types of medical robots that differ in their functionality and design, as well as the scope for various fields of medicine:

Robotic surgeons and robotic surgical systems- used for complex surgical operations. They are not autonomous devices, but a remotely controlled instrument that provides the doctor with accuracy, increased dexterity and controllability, additional mechanical strength, reduces surgeon fatigue, and reduces the risk of hepatitis, HIV and other diseases for the surgical team.

Patient simulation robots- designed to develop decision-making skills and practical medical interventions in the treatment of pathologies. Such devices fully reproduce human physiology, simulate clinical scenarios, respond to the administration of drugs, analyze the actions of trainees, and respond appropriately to clinical stimuli.

Exoskeletons and robotic prostheses- exoskeletons increase physical strength and help with the recovery process of the musculoskeletal system. Robotic prostheses - implants that replace missing limbs, consist of mechanical and electrical elements, microcontrollers with artificial intelligence, and are also capable of being controlled from human nerve endings.

Robots for medical institutions and assistant robots- are an alternative to orderlies, nurses and nurses, nurses, nannies and other medical personnel, are able to provide care and attention to the patient, help in rehabilitation, provide constant communication with the attending physician, and transport the patient.

Nanobots- microrobots operating in the human body at the molecular level. Designed for diagnosis and treatment cancer, research blood vessels and repair of damaged cells, they can analyze the structure of DNA, carry out its correction, destroy bacteria and viruses, etc.

Other specialized medical robots- there are a huge number of robots that help in a particular process of treating a person. For example, devices that are able to automatically move, disinfect and quartz hospital rooms, measure the pulse, take blood for analysis, produce and dispense medicines, etc.

Let us consider in more detail each type of robots using examples of modern automated devices developed and implemented in many areas of medicine.

Robotic surgeons and robotic surgical systems:

The most famous robotic surgeon in the world is the Da Vinci. The device, manufactured by Intuitive Surgical, weighs half a ton and consists of two blocks, one is a control unit designed for the operator, and the second is a four-armed machine that acts as a surgeon. The artificial wrist manipulator has seven degrees of freedom, similar to a human hand, and a 3D imaging system that displays a three-dimensional image on a monitor. This design increases the accuracy of the surgeon's movements, eliminates hand tremors, awkward movements, reduces the length of the incisions and blood loss during the operation.

Robot surgeon Da Vinci

With the help of the robot, it is possible to carry out a huge number of different operations, such as restoration mitral valve, myocardial revascularization, ablation of heart tissues, installation of an epicardial pacemaker for biventricular resynchronization, thyroid surgery, gastric bypass, Nissen fundoplication, hysterectomy and myomectomy, spinal surgery, disc replacement, thymectomy - surgery to remove the thymus gland, lung lobectomy , operations in urology, esophagectomy, mediastinal tumor resection, radical prostatectomy, pyeloplasty, removal of the bladder, ligation and decoupling of the fallopian tubes, radical nephrectomy and kidney resection, reimplantation of the ureter and others.

Currently, the struggle for the market of medical robots and automated surgical systems has unfolded. Scientists and medical device companies are eager to introduce their devices, so every year there are more and more robotic devices.

Da Vinci's competitors include a new MiroSurge surgical robot designed for cardiac surgery, a robotic arm from UPM for precise insertion of needles, catheters and other surgical instruments in minimally invasive surgery procedures, a surgical platform called IGAR from CSII, a robotic system - Sensei X catheter manufactured by Hansen Medical Inc for complex operations on the heart, the ARTAS hair transplant system from Restoration Robotics, the Mazor Renaissance surgical system, which helps perform operations on the spine and brain, a robot surgeon from scientists from the SSSA Biorobotics Institute, and a robot assistant to track surgical instruments from GE Global Research under development, and many others. Robotic surgical systems serve as assistants or assistants for physicians and are not fully autonomous devices.

Robot surgeon MiroSurge

Robot surgeon from UPM

Robot surgeon IGAR

Robot catheter Sensei X

Robotic hair transplant system ARTAS

Robot surgeon Mazor Renaissance

Robot surgeon from SSSA Biorobotics Institute

Surgical instrument tracking robot from GE Global Research

Patient Simulator Robots:

To develop the practical skills of future doctors, there are special robot mannequins that reproduce the functional features of the cardiovascular, respiratory, excretory systems, and also involuntarily respond to various activities students, for example, when introducing pharmacological preparations. The most popular robot patient simulator is HPS (Human Patient Simulator) from the American company METI. You can connect a bedside monitor to it and monitor blood pressure, cardiac output, ECG and body temperature. The device is capable of consuming oxygen and releasing carbon dioxide, just like real breathing. Nitrous oxide may be absorbed or released during anesthesia mode. This function provides training in artificial ventilation of the lungs. The pupils in the eyes of the robot are able to react to light, and the movable eyelids close or open depending on whether the patient is conscious. On the carotid, brachial, femoral, radial popliteal arteries, a pulse is felt, which changes automatically and depends on blood pressure.

The HPS simulator has 30 patient profiles with various physiological data, simulating a healthy man, a pregnant woman, an elderly person, and so on. During the training, a specific clinical scenario is modeled, which describes the scene and the patient's condition, goals, necessary equipment and medicines. The robot has a pharmacological library of 50 drugs, including gaseous anesthetics and intravenous drugs. The manikin is controlled by a wireless computer, allowing the instructor to control all aspects of the training process right next to the student.

Of note is the great popularity of birthing simulators such as the GD/F55. It is designed for the training of medical personnel in the departments of obstetrics and gynecology, allows you to develop practical skills and abilities in gynecology, obstetrics, neontology, pediatrics, intensive care and nursing care in the maternity ward. The Simroid robot imitates a patient in a dentist's chair, its oral cavity exactly repeats the human one. The device is able to simulate the sounds and groans that a person creates if he is in pain. There are robotic simulators for teaching manipulative techniques. This is, in fact, a model of a person with simulators of veins and blood vessels made of elastic tubes. On such a device, students work out the skills of venesection, catheterization, venipuncture.

Exoskeletons and robotic prostheses:

One of the most famous medical devices is the robotic suit - the exoskeleton. It helps people with physical disabilities move their bodies. At the moment when a person tries to move his arms or legs, special sensors on the skin read small changes in the electrical signals of the body, bringing the mechanical elements of the exoskeleton into working condition. Some of the popular devices are the Walking Assist Device (an assistive device for walking) from the Japanese company Honda, the rehabilitation exoskeleton HAL from the Cyberdyne company, widely used in Japanese hospitals, the Parker Hannifin apparatus of Vanderbilt University (Vanderbilt University), which makes it possible to move the joints of the hips and knees, powerful NASA X1 exoskeleton designed for astronauts and paralyzed people, Kickstart exoskeleton from Cadence Biomedical, which does not work on batteries, but uses the kinetic energy generated by a person when walking, eLEGS, Esko Rex, HULC exoskeletons from the manufacturer Ekso Bionics, ReWalk from ARGO, Mindwalker from Space Applications Services, helping paralyzed people, as well as a unique brain-machine interface (BMI) or just an exoskeleton for the brain MAHI-EXO II to restore motor functions by reading brain waves.

The widespread use of exoskeletons helps many people around the world feel complete. Even completely paralyzed people are already able to walk today. A striking example is the robotic legs of physicist Amit Goffer, which are controlled using special crutches and can automatically determine when to take a step, recognize speech signals "forward", "sit", "stand".

Walking Assist Exoskeleton

Exoskeleton HAL from Cyberdyne

Exoskeleton Parker Hannifin

Exoskeleton NASA X1

Exoskeleton Kickstart from Cadence Biomedical

Exoskeleton HULC from Ekso Bionics

Exoskeleton ReWalk from ARGO

Exoskeleton Mindwalker from Space Applications Services

Brain exoskeleton MAHI-EXO II

Exoskeleton by Amit Goffer

But what to do when the limbs are missing? This applies mainly to war veterans, as well as victims of random circumstances. In this regard, companies such as Quantum International Corp (QUAN) and their exoprostheses and the Defense Advanced Research Projects Agency (DARPA), together with the Department of Veterans Assistance, the Rehabilitation Center and the US Development Service, are investing heavily in the research and development of robotic prostheses (bionic arms or legs) that have artificial intelligence, capable of feeling environment and recognize user intent. These devices accurately imitate the behavior of natural limbs, and are also controlled by their own brain (microelectrodes implanted in the brain or sensors read neurosignals and transmit them as electrical signals to the microcontroller). The owner of the most popular bionic arm worth $15,000 is Briton Nigel Ackland, who travels the world and promotes the use of artificial robotic prostheses.

One of the important scientific developments was iWalk BiOM artificial robotic ankles, developed by MIT professor Hugh Herr and his biomechatronics group at the MIT Media Lab. iWalk receives funding from the US Department of Veterans Affairs and the Department of Defense, which is why many disabled veterans who served in Iraq and Afghanistan have already received their bionic ankles.

iWalk BiOM Robotic Ankles

Scientists from all over the world are striving not only to improve the functional features of robotic prostheses, but to give them a realistic look. US researchers led by Zhenan Bao of Stanford University in California have created nanoskin for medical prosthetic devices. This polymer material has high flexibility, strength, electrical conductivity and pressure sensitivity (reading signals like touch panels).

Nanoskin from Stanford University

Robots for medical institutions and assistant robots:

The hospital of the future is a hospital with minimal human staff. Every day, robotic nurses, robotic nurses and telepresence robots are increasingly being introduced into medical institutions to contact the attending physician. For example, Panasonic nurse robots, Toyota Human Support Robot (HSR) assistant robots, InTouch Health's Irish RP7 nurse robot, Korean KIRO-M5 robot and many others have been working in Japan for a long time. Such devices are a platform on wheels and are able to measure heart rate, temperature, control the time of eating and taking medications, notify in a timely manner of problem situations and necessary actions, maintain contact with living medical personnel, collect scattered or fallen things, etc.

Robotic orderlies from Panasonic

Toyota HSR Assistant Robot

Robot nurse RP7 from InTouch Health

Nurse Robot KIRO-M5

Often, in conditions of continuous medical care, doctors cannot physically pay enough attention to patients, especially if they are at a great distance from each other. Developers of robotic medical equipment have tried and created telepresence robots (for example, LifeBot 5, or RP-VITA from iRobot and InTouch Health). Automated systems allow you to transmit audio and video signals via 4G, 3G, LTE, WiMAX, Wi-Fi, satellite or radio communications, measure the patient's heartbeat, blood pressure and body temperature. Some devices can perform electrocardiography and ultrasound, have an electronic stethoscope and otoscope, move around hospital corridors and wards, avoiding obstacles. These medical assistants provide timely care and process clinical data in real time.

Telepresence Robot LifeBot 5

Telepresence robot RP-VITA

For the safe transportation of samples, drugs, equipment and supplies in hospitals, laboratories and pharmacies, courier robots are used with great success. Assistants have a modern navigation system and on-board sensors that make it easy to move around in rooms with a complex layout. Prominent representatives of such devices include American RoboCouriers from Adept Technology and Aethon from the University of Maryland Medical Center, Japanese Hospi-R from Panasonic and Terapio from Adtex.

Robot courier RoboCouriers from Adept Technology

Robot courier Aethon

Robot courier Hospi-R from Panasonic

Robot courier Terapio from Adtex

A separate direction in the development of robotic medical equipment is the creation of transforming wheelchairs, automated beds and special vehicles for the disabled. Recall such developments as the chair with rubber tracks Unimo from the Japanese company Nano-Optonics, (Chiba Institute of Technology) under the guidance of Associate Professor Shuro Nakajima (Shuro Nakajima), using wheel legs to overcome stairs or ditches, the Tek Robotic Mobilization Device robotic wheelchair from Action Trackchair. Panasonic is ready to solve the problem of transferring a patient from a chair to a bed, which requires great physical effort of medical personnel. This device automatically converts from bed to chair and vice versa when needed. Murata Manufacturing Co has teamed up with Kowa to make an innovative medical vehicle, the Electric Walking Assist Car, an autonomous bicycle with a pendulum control system and a gyroscope. This development is mainly intended for the elderly and people who have problems with walking. Separately, we note a series of Japanese robots RoboHelper from Muscle Actuator Motor Company, which are indispensable assistants to nurses in caring for bedridden patients. The devices are capable of lifting a person from a bed to a sitting position or picking up the physical waste of a recumbent person, excluding the use of pots and ducks.

Nanobots:

Nanorobots or nanobots are robots the size of a molecule (less than 10 nm), capable of moving, reading and processing information, as well as being programmed and performing certain tasks. This is a completely new direction in the development of robotics. Areas of application of such devices: early cancer detection and targeted drug delivery to cancer cells, biomedical tools, surgery, pharmacokinetics, monitoring of diabetic patients, production of a device from individual molecules according to its drawings by means of molecular assembly by nanorobots, military use as means of surveillance and espionage, as well as weapons, space research and development, etc.

At the moment, the developments of medical microscopic robots for the detection and treatment of cancer from South Korean scientists are known, biorobots from scientists from the University of Illinois that can move in viscous liquids and biological media on their own, the prototype of the sea lamprey is the Cyberplasm nanorobot, which will move in the human body, detecting diseases at an early stage, engineer Ado Pun's nanorobots, which can travel through the circulatory system, deliver drugs, take tests and remove blood clots, the Spermbot magnetic nanorobot - the development of scientist Oliver Schmidt and his colleagues from the Institute for Integrative Nanosciences in Dresden (Germany) for delivery sperm and drugs, nanobots to replace proteins in the body from scientists from the University of Vienna (University of Vienna) together with researchers from the University of Natural Resources and Life Sciences Vienna (University of Natural Resources and Life Sciences Vienna).

Cyberplasm microrobots

Ado Puna Nanobots

Magnetic nanorobot Spermbot

Nanobots for protein replacement

Other specialized medical robots:

There are a huge number of specialized robots that perform individual tasks, without which it is impossible to imagine effective and high-quality treatment. Some of these devices are the Xenex robotic quartz apparatus and the TRU-D SmartUVC disinfection robot from Philips Healthcare. Undoubtedly, such devices are simply irreplaceable assistants in the fight against nosocomial infections and viruses, which serve as one of the most serious problems in medical facilities.

Xenex robotic quartz apparatus

Philips Healthcare TRU-D SmartUVC disinfection robot

Collecting a blood sample is the most common medical procedure. The quality of the procedure depends on the qualifications and physical condition of the medical worker. Often, an attempt to draw blood the first time ends in failure. Therefore, to solve this problem, the Veebot robot was developed, which has computer vision, with which it determines the location of the vein and gently guides the needle there.

Veebot Blood Collection Robot

The Vomiting Larry Vomiting Robot examines noroviruses that cause 21 million diseases, including symptoms of nausea, watery diarrhea, abdominal pain, loss of taste, general lethargy, weakness, muscle pain, headache, cough, subfebrile temperature, and, of course, strong vomiting.

Robot for studying the vomiting process Vomiting Larry

The most popular robot for children remains PARO - a fluffy children's toy in the form of a harp seal. The therapeutic robot can move its head and paws, recognize voice, intonation, touch, measure the temperature and light in the room. Its competitor is HugBot, a giant huggable teddy bear robot that measures heart rate and blood pressure.

PARO therapy robot

Bear Robot HugBot

A separate branch of medicine dealing with the diagnosis, treatment of diseases, injuries and disorders in animals is veterinary medicine. To train qualified specialists in this field, the College of Veterinary Medicine in the development of robotic pets creates unique training robots in the form of dogs and cats. To approximate the exact behavior of an animal, software is being developed separately at the Center for Advanced Computing Systems at Cornell University (CAC).

Robot trainers in the form of dogs and cats

The effectiveness of robots in medicine:

Obviously, the use of robots in medicine has a number of advantages over traditional treatment involving the human factor. The use of mechanical hands in surgery prevents many complications and errors during operations, reduces postoperative recovery period, reduce the risk of infection and infection of the patient and staff, exclude large blood loss, reduce pain, contribute to a better cosmetic effect (small scars and scars). Robotic medical assistants and rehabilitation robots make it possible to pay close attention to the patient during treatment, control the recovery process, limit live staff from laborious and unpleasant work, and allow the patient to feel like a full-fledged person. Innovative treatments and equipment bring us closer every day to a healthier, safer and longer life.

Every year, the global market for medical robots is replenished with new devices and is undoubtedly growing. According to Research and Markets, the market for rehabilitation robots, bioprostheses and exoskeletons alone will grow to $1.8 billion by 2020. The main boom in medical robots is expected after the adoption of a single standard ISO 13482, which will become a set of rules for structural elements, materials and software used in devices.

Conclusion:

Without a doubt, we can say that medical robots are the future of medicine. The use of automated systems significantly reduces medical errors and reduces the shortage of medical personnel. Nanorobotics helps to overcome serious diseases and prevent complications at an early stage, and to widely use effective nanodrugs. Within the next 10-15 years, medicine will reach a new level with the use of robotic service. Unfortunately, Ukraine is in a deplorable state regarding this branch of development. For example, in Russia in Yekaterinburg, the famous robot surgeon "Da Vinci" performed his first operation back in 2007. And in 2012, President Dmitry Anatolyevich Medvedev instructed the Russian Ministry of Health, together with the Ministry of Industry and Trade, to work out the issue of developing new medical technologies using robotics. This initiative was supported by the Russian Academy of Sciences. The reality is that in the absence of real support from the Ukrainian authorities in the development of the field of medical robotics, our state lags behind other civilized countries every year. From this follows an indicator of the level of development of the country as a whole, because care for the health and life of a citizen, mentioned in the main law - the Constitution of Ukraine, is "the highest social value."

LLC "OLME" St. Petersburg., Ph.D. Vagin A.A.

Development of robotics in restorative medicine, rehabilitation of immobilized patients - problems and solutions.

Competition today is determined not by the possession of large resources or production potential, but by the amount of knowledge accumulated by previous generations, the ability to structure it, manage it and use it personally.
One of the important tasks of the World Health Organization (WHO) is the introduction of promising IITs with AI methods and tools for joint information interaction and use in clinical medicine.

The modern concept of intelligent information systems involves the combination of electronic patient records (electronic patient records) with archives of medical images, monitoring data with medical devices, the results of the work of the sponsored laboratories and tracking systems, the availability of modern means of information exchange (electronic intrahospital mail, Internet, videoconferencing, etc.).

At present, a promising preventive direction in the form of restorative medicine, which has developed on the basis of the principles of sanology and valeology, has received active formation and intensive development. High morbidity and mortality, a steady decline in the quality of life, a negative population growth contributed to the development and implementation of an independent preventive direction in practical medicine.

However, the current economic, social, legal, medical institutions perform functions mainly in the treatment and rehabilitation of the disabled, the issues of prevention and rehabilitation treatment of the disease are not sufficiently addressed. The economic and social situation in our country contributes to the emergence of a sense of fear and tension in the presence of an injury or illness in a person, is a source of psychosocial problems.

The need for active health preservation in the conditions of the infrastructure of medical organizations is determined by the desire to bring medicine to a new stage of development. However, its further reform is difficult not only due to insufficient funding of this industry, but also clear uniform standards and methods for planning, pricing, billing of medical services, as well as the distribution of responsibility between executive authorities and its subjects for the implementation of certain volumes of medical care.

Over the past decade, significant progress has been made in medical robotics. Today, several thousand prostate surgeries are performed using medical robots with the least possible trauma for patients. Medical robots make it possible to ensure minimal invasiveness of surgical operations, faster recovery of patients, and minimal risk of infection and side effects. Although the number of medical procedures performed by robots is still relatively small, the next generation of robotics will be able to provide surgeons with greater opportunities for visualization of the surgical field, feedback from the surgical instrument, and will have a huge impact on progress in surgery.

As the population ages, the number of people suffering from cardiovascular diseases, strokes and other diseases continues to rise. After a heart attack, stroke, spinal injury, it is very important that the patient, as far as possible, exercise regularly.

Unfortunately, the patient is usually forced to engage in physical therapy in medical institution, which is often impossible. The next generation of medical robots will help patients perform at least part of the necessary physical exercises at home.
Robotics is also beginning to be used in healthcare for the early diagnosis of autism,
memory training in people with mental disabilities.

Development of robotics in other countries.

The European Commission recently launched a 600 million euro robotics program to strengthen the manufacturing and service industries. Korea plans to invest 1 billion US dollars in the development of robotics within 10 years. Similar but smaller programs exist in Australia, Singapore and China. In the United States, funding for research and development in the field of robotics is carried out mainly in the defense industry, in particular for unmanned systems. But there are also programs for the development of robotics in the field of healthcare and services. Despite the fact that the robotics industry was born in the USA, the world leadership in this field now belongs to Japan and Europe. And it is not very clear how the US will be able to maintain its leading position for a long time without a national commitment to the development and implementation of robotics technology.

Existing structural units carry out the stages of rehabilitation measures according to the principle: hospital - inpatient treatment - clinic. At the first stage of inpatient care, the complications of an acute disease are eliminated and prevented, the process is stabilized, and physical and mental adaptation is carried out.

The sanatorium-resort stage (II) is an intermediate link between a hospital and a polyclinic, where, with a relative stabilization of clinical and laboratory parameters, medical rehabilitation of patients is carried out based on the use of healing natural factors. Stage III is a polyclinic, the main purpose of which, at the modern level of outpatient care, is to identify the compensatory capabilities of the body, their development within reasonable limits, and also to implement a set of measures aimed at combating risk factors for concomitant complications and worsening diseases. However, this system of assistance is not always feasible in practice.

The main difficulty is the significant economic and financial costs of hospitalization of patients, especially with the borderline stage of the disease, the high cost of sanatorium treatment, and the insufficient equipment of polyclinics with modern methods of examination and treatment.

Currently, there are several international standards for registering clinical data in the MIS of medical institutions:

• SNOMED International (College of American Pathologists, USA);
• Unified medical language system (National Medical Library, USA);
• Read clinical codes (Center for Coding and Classification of the National Health System, UK).

AT last years in the United States, most large medical centers no longer function without information systems (IS), which account for more than 10% of hospital spending.
In the US healthcare sector, information technology spends approximately $20 billion a year. Of particular interest are medical systems that directly help the doctor to increase work efficiency and improve the quality of patient care.

The studies carried out over the past five years have made it possible to more fully understand the processes occurring in spinal cord injury and its consequences, as well as the principles of influencing the negative aspects occurring in the area of ​​injury. Such close attention to this particular category of patients is explained by the severity of the consequences arising in the process of injury and the subsequent further development of traumatic disease of the spinal cord.

A morphological study of the injured spinal cord (SC) indicates that tissue damage is not limited to the area of ​​impact of the destructive force, but, capturing primarily intact areas, leads to the formation of a more extensive injury. At the same time, the structures of the brain, as well as the peripheral and autonomic nervous systems, are involved in the process. It has been established that sensory systems change much more deeply than motor systems.

The modern concept of the pathogenesis of traumatic SM injury considers two main interrelated mechanisms of cell death: necrosis and apoptosis.
Necrosis is associated with direct primary damage to the brain tissue at the time of application of traumatic force (contusion or compression of the brain parenchyma, dyscirculatory vascular disorders). The necrotic focus subsequently evolves into a glial-connective tissue scar, near which small cavities form in the distal and proximal parts of the spinal cord, forming post-traumatic cysts of various sizes.

Apoptosis is a mechanism of delayed (secondary) cell damage, which is their physiological death, which is normally necessary for tissue renewal and differentiation. The development of apoptosis in spinal cord injury is associated with the effect on the cell genome of excitatory amino acids (glutamate), Ca2+ ions, inflammatory mediators, ischemia, etc.
Initially, apoptosis of neurons is observed near the necrotic focus (the peak of death is 4-8 hours). Then apoptosis of micro- and oligodendroglia develops (the peak of death is the third day). The next peak of glial apoptosis is observed after 7-14 days at a distance from the site of injury and is accompanied by the death of oligodendrocytes.
Secondary pathological changes include petechial hemorrhages and hemorrhagic necrosis, free radical lipid oxidation, increased protease activity, inflammatory neurophagocytosis and tissue ischemia with further release of Ca2+ ions, excitatory amino acids, kinins, and serotonin. All this is ultimately manifested by widespread ascending and descending degeneration and demyelination of nerve conductors, the death of part of the axons and glia.

Disorders in the activity of a number of organs and systems that were not directly affected by trauma create new diverse pathological situations. In denervated tissues, sensitivity to biological active substances(acetylcholine, adrenaline, etc.), the excitability of receptive fields increases, the threshold of the membrane potential decreases, the content of ATP, glycogen, and creatine phosphate decreases. In paretic muscles, lipid and carbohydrate metabolism is disturbed, which affects their mechanical properties - extensibility and contractility, and contributes to rigidity.

The disorder of mineral metabolism leads to the formation of paraosseous and periarticular ossifications, ossifying myositis, osteoporosis.
All this can cause new complications: bedsores, trophic ulcers, osteomyelitis, joint-muscular contractures, ankylosis, pathological fractures, bone deformities - in the musculoskeletal system; stone formation, reflux, inflammation, kidney failure - in the urinary system. Relationships are formed that are destructive. There is oppression and functional loss of a number of systems that were not directly affected by the injury. Under the influence of a continuous stream of afferent impulses, active nerve structures fall into a state of parabiosis and become immune to specific impulses.

In parallel, another dynamic line is being formed - restorative-adaptive functional changes. Under conditions of deep pathology, the optimally possible restructuring of the mechanisms for ensuring adaptation to the environment occurs. The body moves to a new level of homeostasis. Under these conditions of hyperreactivity and stress, traumatic spinal cord disease (TSCD) is formed.
In order to test the assumption about the existence of ways to prevent the formation of scar tissue in the area of ​​spinal cord injury, before the germination of axons of neurons through it (working hypothesis), Vagin Alexander Anatolyevich conducted experimental work on Wistar rats. Well-developed and healthy animals with good behavior, sexually mature, one year old were selected for the experiments.

All experimental procedures and manipulations were carried out in the operating room of the Department of Pathological Physiology of the Military Medical Academy under conditions that meet the requirements of SanPiN 2.1.3.1375-03. The animals were placed on the operating table. Ether anesthesia was used. In the control group (group A) there were 22 rats, in the main groups (groups B and C) - 21 and 22, respectively. All animals underwent partial (under ether anesthesia) denervation of the lower part of the spinal cord at the level of the 3rd thoracic vertebra. Experimental denervation in experimental animals was performed under sterile conditions in compliance with the rules of asepsis and antisepsis. For spinal injury in rats, only a straight needle 1.2x40 mm and suture material were used to apply a compressive loop on the spinal cord (supramid thread 0.1 mm in diameter is sterile). After the infliction of experimental injury in the postoperative period, the animals of different groups were kept differently, but all were immersed in drug-induced sleep (Sol. Relanii 0.3 intraperitoneally, 2 times a day) for the entire observation period.

The control group (A) was kept in standard conditions, and in rats of the main groups (B and C), the method of keeping under conditions of fixation in a special cuvette was used. The device with a cuvette served as a prototype of the “optimal reducing environment” and consisted of a fixed bed made of a polyurethane pipe 5 cm in diameter, 10 cm long, dissected along the length leaving petals 5 cm long, 1 cm wide for fixing the paws of the animal. The petals of the cuvette are connected to the moving levers of the electric motors (4 pieces), the rods of which make linear movements allowing you to make the specified movements of the animal's paws (passive movements) through a relay device that receives commands from an industrial computer according to a given program. In the described bed, the animal was placed on its back. His paws were fixed to the petals of the cuvette. Passive movements were carried out in the form of abduction and adduction of the animal's limbs. Possible active movements in animals were carried out by them during periods of awakening.

The experiment was carried out in two directions:

1. Changes in sections of the spinal cord of animals after injury were studied in all groups under light and electron microscopes.
2. During the observation of the animals of the control and main groups, the terms of recovery of pain, temperature sensitivity, as well as motor activity were recorded.

As a result of histological, pathophysiological studies, the following results were obtained. In a histological study of sections of the spinal cord of rats in the control group A, cell death as a result of injury after direct damage to the spinal cord occurs as a result of necrosis and lasts up to 14 days. In the future, cell death occurs as a result of apoptosis, which is observed up to 21-30 days with the formation of scar tissue. Scar tissue is formed from degenerated randomly located myelin fibers and axial cylinders that do not allow neuronal axons to grow through the scarring zone. The area of ​​scar tissue formation includes the nuclei of cells passing into the stage of apoptoid bodies.

At the same time, in the main group B* - (B and C), a distinct histological picture of neuroglia and neuron cell recovery under the conditions of the PDIC method is revealed.
When processing the statistical materials of the experimental pathophysiological part of the study, the data in group A for the restoration of pain and temperature sensitivity, as well as motor function not marked.
In group B* - (B and C) recovery of pain sensitivity was observed in 21.5% of cases, in 78.5% of cases there was no recovery. Restoration of temperature sensitivity was noted in 15.4% of experimental animals, in 84.6% of cases no recovery was noted. As a result of studying changes in motor activity, recovery was observed only in the main group B*. It was noted that movements in the limbs were restored in 26.2% of the animals, in 73.8% of cases, recovery did not occur. According to the data of non-parametric analysis on the state of pain, temperature sensitivity, motor function in the studied rats, it has a significant (p<0,05) влияние на комплекс реабилитационных лечебных мероприятий с использованием метода постоянной длительной импульсной кинетикотерапии. Все данные используемые в анализе измерялись в номинальной шкале, для которой используются следующие критерии: Фи, V Крамера и коэффициент сопряженности, подтверждающие выявленные значимости различий встречаемых параметров в исследуемых группах (р<0,05).

Practical testing of the experimental system on experimental animals led to the conclusion that a rehabilitation technique aimed at adequate use of the discovered phenomenon of creating optimizing conditions for restoring the functions of the damaged SM should provide the following conditions:

• periodic creation of irritation of the efferent and afferent pathways above and below the focus of damage to the spinal cord;
• closure of the reflex arc and thus the activation of the segmental-reflex apparatus of the spinal cord after the same period of time, with the same force, in the same sequence for a long time;
• work around the clock throughout the rehabilitation period.

Analysis of the results of the experimental part of the work showed that the use of the method of continuous long-term pulsed kinetic therapy in the post-traumatic period in clinical conditions in patients with the consequences of spinal injuries can stimulate the restoration of lost functions of organs and systems.

When transferring the experimentally confirmed model of the optimal physiological environment to the platform of clinical testing, we proceeded from the fact that the basis of the developed new method of rehabilitation treatment of such patients will have to solve the main tasks of rehabilitation:

• creation of the most favorable conditions for the course of regenerative processes in the spinal cord;
• prevention and treatment of bedsores, fistulas, osteomyelitis, contractures, deformities of the osteoarticular apparatus;
• elimination or reduction of pain syndrome;
• the establishment of independent controlled acts of urination and defecation;
• prevention and treatment of complications from the urinary, respiratory and cardiovascular systems;
• prevention and treatment of atrophy and muscle spasticity;
• development of the ability to move independently and self-service.

With the financial support of OLME LLC, a rehabilitation kinetic system was created, which contributes to the automatic conduction of periodically generated stimulation of the efferent and afferent pathways, the closure of the reflex arc and, thereby, the activation of the segmental-reflex apparatus of the spinal cord through the same gap time, with the same force, in the same sequence around the clock throughout the entire time the patient is in rehabilitation (days, weeks, months and years) and allows you to save the musculoskeletal system, peripheral nervous system and segmental apparatus, thus allowing to talk about new approaches to rehabilitation.

Despite the lack of funding from the state, today the company "OLME" has laid the foundations of robotics with information technology for the rehabilitation of immobilized patients for a long time at home in our country. This direction of development of rehabilitation makes it possible to significantly reduce mortality and disability in this category of patients, increase life expectancy and, in most cases, return to full-fledged work in 4-5 years.

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