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gaps and delays in the spread of broadband: on the one hand, they are the only pos- sible solution to the digital divide absolute (pure scenery satellite) and, on the other hand, they can increase the quality of telecommunications, where digital terrestrial service is already available (hybrid terrestrial and satellite scenario) [10] (Fig. 19.3).
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clinicians; enhancing the efficacy of clinician’s therapies; and increasing the ease of activities in daily life.
The development of robot-aided tools for geriatric rehabilitation is a very stimu- lating prospective when considering their highly rehabilitative and assistive poten- tials. The main characteristics of all robot-aided treatment are the possibility to administer high-intensity and repetitive therapy. In fact, chronic subjects showed significant improvement in motor functions with intensive robot-assisted training, which may supplement the standard multidisciplinary rehabilitation programs, as our studies demonstrated [13, 14]. In particular, various robotic devices that assist and train upper extremity movements and hand function with various levels of com- plexity and functionality have been developed in the last 10 years. These devices range from simple mechanisms that support single-joint movements to more com- plex mechanisms with as many as 18 degrees-of-freedom (DOF) for multi-joint movements of the wrist and fingers.
The first results from clinical studies indicate that robot-assisted hand rehabilita- tion reduces motor impairments of the affected hand and the arm and improves the functional use of the affected hand. The different motor impairments of the hand can be viewed as resulting from problems in either motor execution or motor plan- ning/learning. Deficits in motor execution result from weakness of wrist/finger extensors, overactive wrist/finger flexors (increased tone and spasticity), co- contraction, impaired finger independence, poor coordination between grip and load forces, inefficient scaling of grip force and peak aperture, and delayed prepara- tion, initiation, and termination of object grip (Fig. 19.4).
Fig. 19.4 Fingers Extending eXoskeleton (FEX) for rehabilitation and regaining mobility (Patent:
PCT/IB2015/059313)
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Various devices are described in literature and have been developed to train the wrist/
forearm movements, individual finger movements, simultaneous finger and thumb movements (such as palmar or precision grasp), or a combination of these [15, 16].
Robotic gait training uses several devices to assist the patient move and maintain balance. Canes, crutches, walkers, and platforms are simple ambulatory-assistive devices that modify a patient’s independence and functional mobility. Robot-aided walking and wearable robotic exoskeleton are considered a promising tool for gait rehabilitation in various diseases [16].
The robotic devices have been developed to relieve physical therapists from the strenuous and not ergonomic burden of manual body weight support (BWS).
Furthermore, the use of robotic devices is currently advised to prevent the risk of falls and to improve gait velocity, keeping patients safe. The robotic machines can be used either as exoskeleton or end effectors, allowing practice up to 1000 steps for each session. Currently, a robotic task-specific repetitive approach, i.e., numerous practices of complex gait cycles, is regarded as the most promising to restore motor function after neurological or orthopedic diseases. Moreover, exoskeleton devices can be used to give inpatients an intensive program (in terms of many repetitions) of complex gait cycles and to allow their use in outdoor conditions [17–19].
Conclusion
Technological innovation in smart home, robotics, and ICT represents an effec- tive solution to tackle the challenge of providing social sustainable care services for the aging population. The recent introduction of wearable technologies is opening new opportunities for the provisioning of advanced gerontechnology services based on the cooperation of a number of connected robots, smart envi- ronments, and other devices.
Key Points
• New devices were developed to help older subjects with limitation in daily activities and memory functions and for health monitoring in order to remove caregiving burden.
• Smart homes have been defined as the integration of technology and ser- vices through home networking for a better quality of life.
• The term “domotics” was commonly used to describe any system in which informatics and telematics were combined in order to support home activi- ties. This word refers specifically to the application of computer and robot technologies to domestic appliances.
• Rehabilitation robotics (RR) and the assistive robotics (AA) are branches of robotics, which focus on devices or machines that can enhance recovery in people with disability or help them in daily activities.
• Robot-aided walking and wearable robotic exoskeleton are considered a promising tool for gait rehabilitation in various diseases.
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S. Masiero, U. Carraro (eds.), Rehabilitation Medicine for Elderly Patients, Practical Issues in Geriatrics, DOI 10.1007/978-3-319-57406-6_20 P. Rumeau
Telemedicine Activity, Pôle Gériatrie du CHU de Toulouse, Toulouse, France e-mail: [email protected]