Hello, Tomorrow!

Imagining How Robotics & Complex Wheelchairs Will Interact In The Future

• By Haley Samsel
• Apr 01, 2020

When Dan Ding started her new job at the University of Pittsburgh in 2001, she had never heard the term “rehabilitation robotics.” She attended robotics conferences while earning her Ph.D. in Hong Kong, but rarely saw sessions on healthcare, much less the type of work that would soon change complex rehab technology (CRT) — the industry that designs, manufactures, custom fits and custom builds wheelchairs for people with significant mobility-related disabilities, such as spinal cord injuries, cerebral palsy or muscular dystrophy.

“I don’t think at the time the term was coined,” Ding, now an associate professor in the university’s Department of Rehabilitation Science and Technology, said. “I definitely witnessed the whole growth of this technology’s involvement in rehabilitation and assistive technology, so I feel very fortunate that, before that happened, I was able to get into this field.”

Ding’s early experiences are a far cry from the landscape of robotics in complex rehab today, where startups have introduced technology ranging from systems that allow users to control their wheelchairs with their eyes to blind spot sensors that alert power chair users when they are about to hit a corner or object.

While there is a sense of unlimited possibilities for robotic technology, experts say there are also immense challenges, particularly in terms of the high costs for patients seeking the latest equipment and the regulatory hurdles for CRT companies trying to bring innovative products to market.

For Pooja Viswanathan, the CEO and founder of the Toronto-based blind-spot sensor manufacturer Braze Mobility, the CRT industry is just “skimming the surface” of what’s possible in terms of finding solutions for patients.

“I think there’s tremendous opportunity

for growth as long as it’s customer-centric,” Viswanathan said. “The challenge in robotics is that it often ends up being a technology push. As long as the focus stays on the problems rather than the solutions and on the customer rather than the developer, there is tremendous opportunity.”

A WINDING ROAD FOR IBOT & TOYOTA

The path for robotics in complex rehab has been long and winding over the past two decades, including the widely publicized production (and later discontinuation) of the iBOT stair-climbing wheelchair system.

In 2003, Independence Technology — a division of healthcare giant Johnson & Johnson — introduced the iBOT to rave reviews from mainstream media, who hailed the wheelchair as a revolutionary device that “will force [wheelchair users] to reconsider virtually all the presumed boundaries in the world,” according to one Dateline NBC reporter.

But with iBOT’s lack of positioning functions such as tilt and recline, as well as its $26,000 price tag, Independence Technology struggled, ultimately dissolving in 2009. The iBOT has been revived by others, including Toyota North America and most recently by Mobius Mobility, which began marketing the chair in 2019 with some added positioning functions.

Toyota is no longer involved with the iBOT nearly four years after signing an agreement with inventor Dean Kamen to develop the “next generation” of iBOT, according to Doug Moore, the GM, Technology for Human Support at Toyota North America. Instead, Toyota has been at work on mobility-related projects including an AI robot with voice control capability.

“We have been spending a ton of time, especially in this complex rehab area, making sure that we understand the real needs,” Moore said. “We’ve been looking at the end customers, whether it’s direct users, caregivers, care receivers or [healthcare professionals].”

Moore stopped short of committing to any mobility product releases from the company. At the same time, he stressed that Toyota is focused on developing inclusive products.

“I’ve intentionally tried to make sure we don’t over-promise and under-deliver, because there’s still a lot of thinking that has to go into these platforms to make sure we can execute it right,” Moore said.

ROBOTICS PRODUCTS COME TO COMPLEX REHAB

Robotics engineers in the CRT and mobility world have one trait in common: a desire to see their algorithms and technical work turn into an application that changes people’s lives.

For Jay Beavers, a co-founder and managing member of Seattle-based Evergreen Circuits, the inspiration came from Steve Gleason, the former pro football player turned ALS activist. When Gleason challenged a group of Microsoft employees to create a system allowing him to drive his wheelchair with his eyes, they answered the call.

After Microsoft decided not to go into the medical device sector, Beavers and his partners created their own company and began to sell the Independence Drive system, which combines a power wheelchair, tablet computer and eye-tracking camera.

“The thing that I think robotics will do that will really impact this industry is provide for more independent living and to reduce the need for 24-hour caregivers,” Beavers said in an interview, referring to the ability of the eye-gaze system to give independence back to users.

Prior to founding Braze Mobility, Viswanathan spent time researching and interviewing wheelchair users, listening to their concerns about damage in their homes and the myriad issues that come with navigating tight, indoor spaces in power chairs.

“We realized that the issues here were very, very different to what [previous engineers] thought they were,” Viswanathan said.

Through working with users of her product, Viswanathan found that end users were used to being treated as “study participants” rather than feeling shared ownership in the process of developing a product.

“The participants often don’t get a sense that their input is really valued, and they don’t often see where that input is going,” Viswanathan said. “We really flipped that model around and said … ‘You’re really the experts in telling us what the challenge is. You’re the expert in the pain point, and we can execute.’”

Ding, the University of Pittsburgh professor and researcher, has also sought to ensure that engineers consider the experience of patients. While working with some “hardcore” engineers on a robotic arm project, Ding noticed that the engineers were more focused on developing a newer algorithm than how the patient would react to it.

“They care about the final performance, but not the whole process, the user involvement, their acceptance or adoption,” Ding said.

OVERCOMING INDUSTRY OBSTACLES

Beyond working with end users to develop their products, both Viswanathan and Beavers said they have had to overcome regulatory and business challenges, whether that meant putting their product on the market without a Medicare payment code or convincing clinicians and distributors that their innovation brings value to patients.

“One of the things that makes this industry challenging is that it’s not customer acceptance, it’s acceptance of the whole CRT process,” Beavers said. “I’ve known from very early on that there is a high degree of customer desire for Independence Drive, but that does not necessarily mean that it’s going to be a success when it comes to [insurance] coverage and regulation.”

As an academic researcher, Viswanathan heard comments about resistance from healthcare professionals and the stereotypes that “clinicians are averse to new technologies.” But after working with clinicians — such as physical and occupational therapists — she came to a different conclusion.

“If anything,” she said, “clinicians were our biggest advocates right from the beginning in terms of giving us critical feedback that was really important. It wasn’t just criticism, it was very constructive, telling us areas we needed to work on.”

Viswanathan noted that it’s easy to criticize the industry by saying that the high number of stakeholders involved stifles technological innovation. But the complexity in the field and the level of customization needed for each individual wheelchair makes innovation difficult in the first place, she said.

LIMITATIONS & OPPORTUNITIES FOR THE FUTURE

There is no question that there have been major developments in the use of robotic elements in complex rehab, ranging from the Obi robotic dining companion to the ReWalk exoskeleton systems to the products designed by Braze and Evergreen.

Wheelchair manufacturers like Permobil have also been on the forefront, with the company’s “connected chair” integrating a tool called Virtual Seating Coach. Ding and other researchers at the University of Pittsburgh developed the technology, which allows users to monitor how they use power seat functions and learn how to properly take advantage of those functions.

But Ding and her fellow robotic engineers are also some of the first to note the limitations of this technology, as well as the challenges that come with high costs due to lack of insurance coverage and the limited market for CRT products.

“People with disabilities are so diverse, and it’s really hard to have one model fit all, and on the other hand, [products] are expensive, and we have all these policy issues,” Ding said. “It makes it really hard to make this technology mainstream.”

Products incorporating robotic technology will continue to come down the pipeline, including the kind of automation already available in the automotive industry, Viswanathan said. But it’s crucial for engineers, providers and clinicians to realize that a wheelchair is not a car, and many end users view it as an extension of themselves, she added.

“I think where the work needs to be done is really in making sure there is more communication and conversation going on between the end users and the people who are developing these products and sharing those lived experiences to create more empathetic designers,” Viswanathan said.