A robotic wheelchair helps to improve the physical condition of people with Duchenne muscular dystrophy

How can care robotics help patients with Duchenne muscular dystrophy (DMD)? This inherited neuromuscular disorder affects one in 3,500 children worldwide. It causes the progressive loss of muscle function and therefore leads to progressive disability. Despite advances in treatment, patients have an average life expectancy of 35 years and already need an electric wheelchair in their teens.

Jun 17, 2020

Electric wheelchairs are an essential technology to support mobility and maintain independence and social participation. However, continued use leads to high levels of sedentary behaviour, which in turn lead to secondary functional deterioration of the muscular, skeletal, cardiovascular and respiratory systems and to accelerating the loss of arm function.

Appropriate and long-term physical training can help preserve the functional abilities of people with Duchenne muscular dystrophy. The wheelchair developed in the framework of the MOVit project integrates robotic arms instead of armrests. The system allows users to control the direction and speed of the wheelchair just by performing a cyclical arm motion.

Instead of using a joystick, with MOVit patients have the opportunity to drive the chair by exercising muscle arms, which suffer from loss of tone due to the disease. In addition, the system can be adapted to the activity and physical training needs of each patient.

The system has been incorporated to an existing wheelchair model and it is the result of teamwork between Joan Lobo, a former researcher at the consolidated research group Robot Perception and Manipulation of the Institute of Robotics and Industrial Informatics (IRI), which is a joint research centre of the Higher Spanish National Research Council (CSIC) and the Universitat Politècnica de Catalunya · BarcelonaTech (UPC); Julita Medina, a doctor at the Physical Medicine and Rehabilitation Service of the Sant Joan de Déu Hospital and a researcher at the Sant Joan de Déu Research Institute (IRSJD); and Josep Maria Font, a researcher at the Department of Mechanical Engineering and the UPC’s Biomedical Engineering Research Centre (CREB). The project has had the support of the University of California, Irvine (UCI) and the organisation Duchenne Parent Project Netherlands, which has funded the MOVit robotic wheelchair.


Dynamic and tailored physical training

International care guidelines for DMD recommend performing certain exercises on a regular basis and avoiding high-intensity exercises. Although there is no consensus on a specific exercise routine, a study has shown that an appropriate and long-term physical training routine (assisted bicycle training of the legs and arms for 6 months) can help to preserve functional abilities of people with DMD.

Currently, users in wheelchairs whether electric or not need to go or be taken to the exercise machines or equipment and then exercise for a fixed period of time. In contrast, people without a disability have many opportunities to integrate exercise into daily life: cycling or walking to work, climbing stairs, etc. Integrated daily exercise is one of the most effective ways to promote health and wellbeing.

Young DMD patients aged between 12 and 18 participated in the pilot study of the MOVit project, which was conducted between July and November 2019 in the Biomechanical Engineering Lab at the UPC’s CREB. The study aimed to check if they could control the wheelchair correctly by moving their arms and to compare driving performance using a conventional joystick. In addition, the study determined how resistance, arm movement amplitude and frequency affect heart rate and arm muscle activation.


Driving through arm motion

The MOVit system is a wheelchair with two robotic arm supports that is driven just by performing a cyclical arm motion. The right arm motion controls the speed of the right wheel and the left arm motion controls the speed of the left wheel. You can switch the direction of wheel rotation just by pressing a button on the top of the handle.

Other driving tests performed with a MOVit system prototype in a group of 24 healthy people showed that, after 30 minutes of training, driving accuracy and speed were comparable to those using a joystick. Heart rate and oxygen consumption data indicated that the MOVit system provides low-intensity exercise training similar to walking.


MOVit Game, an interactive gaming platform

MOVit is also complemented by the MOVit Game project, an interactive game to encourage patients to do physical training and physiotherapy exercises, which are usually repetitive, monotonous and thus unattractive.

The idea is to provide people with DMD with an interactive gaming platform for controlled exercise, which will be used in combination with the MOVit wheelchair. This project is funded by the organisation Duchenne Parent Project España and also developed by Joan Lobo, who works currently as a rehabilitation engineer at the spin-off Able Human Motion; Josep Maria Font, the CEO of the company and the head of the Biomechanical Engineering Lab of the UPC’s CREB; Dani Tost, a researcher and the head of the Computer Graphics Department of the CREB; and Carme Torras, a researcher at the Robot Perception and Manipulation research group of the IRI, with the supervision of Julita Medina, a doctor at the Sant Joan de Déu Hospital and the IRSJD.

The gaming platform will have a narrative plot based on searching and collecting objects. Researchers will determine the most suitable technological alternatives for presenting the objects, such as interactive projections, a mobile robot and a virtual reality headset.