If You Fall, Israeli Technology Will Catch You

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Pepper, a socially assistive robot, is being modified at Ben-Gurion University of the Negev to help rehabilitate patients with Parkinson’s disease or those who have suffered strokes. Pixabay Creative Commons

BEERSHEVA, ISRAEL — The future is here, and it involves your bubbe playing video games with a talking robot.

OK, let’s backtrack.

There’s incredible technology coming out of Israel for use in the biomedical field worldwide — artificial intelligence, robotics, neurosciences.

A lot of that technology isn’t lost on older adults. In fact, some is being used to rehabilitate patients or help restore their balance, giving them more control and freedom in their lives.

At Ben-Gurion University of the Negev (BGU) in Beersheva, Shelly Levy-Tzedek, lecturer in the Leon and Matilda Recanati School for Community Health Professions in the Department of Physical Therapy, is developing research on movement control using a child-sized interactive robot named Pepper.

Pepper is a humanoid robot created by SoftBank Robotics, a Japanese company, but Levy-Tzedek and her team bought one and are modifying it to help rehabilitate patients with Parkinson’s disease or those who suffered strokes.

Pepper plays interactive games with the patient while talking to him or her; hopefully, down the line, Pepper will remember facts about the patient as they spend time together.

It’s a memory game: Pepper asks the patient to match a row of colored cups to that on the screen on its chest within a set time frame.

“It uses social cues, speech and movement in order to get the person to [react],” Levy-Tzedek said.

“Training the muscles following strokes, regaining muscle strength, is important but not sufficient in order to regain function, the ability to perform this task that is lost,” she explained. “It can only be regained if you actually perform that function over and over again.

“What we’re designing are functional games,” she continued, “with robots that get you to perform that task that you need to perform anyway repeatedly, but get to perform in a game environment with a robot.”

Levy-Tzedek said what they ultimately want to develop with Pepper is facial recognition.

“So it will tell you, ‘Hi, Jane. Good morning. How are you today? How was your grandson’s visit this weekend?’ Have some more social aspect to it, and also know where you finished last week, how well you did last week, and start from that level,” she said.

Levy-Tzedek said many physical therapy patients often dismiss their “homework.” With Pepper, they want to fill that gap between going to a physical therapist and having a partner that encourages you to do the work while tracking your overall performance.

In a few years, Pepper will be more affordable and could possibly be placed in clinics so patients can use it a couple times a week as part of their rehabilitation. The goal is to also be able to rent Pepper to bring home, similar to renting crutches or a walker.

They’re still working on Pepper becoming even more human-like, like being able to hand the patient objects.

A clinical study is planned for this summer with 60 patients.

“What we want to [find] … is whether indeed people prefer to play with it as opposed to alone,” she noted. “And also whether they actually show their functional improvement.

“This is definitely not to replace a physical therapist. It’s an addition,” she noted.

Itshak Melzer created another addition to physical therapy, and it’s as simple as walking on a treadmill.

Melzer, a BGU lecturer also in the Department of Physical Therapy, developed the Balance Measure and Perturbation System (BaMPer) as a way to improve balance control for the elderly.

According to Melzer, one in three older adults over the age of 65 will fall. For those 80 and older, the rate is one in two.

The costs of falling are exponential — $20 billion a year in the U.S. goes to hip fractures, replacements and the like.

The mechanism uses 16 infrared cameras to capture movement from all angles. A patient walks on a treadmill while attached to a harness. Their only instructions are to walk.

The treadmill moves and shifts randomly to simulate the unexpected feeling of falling. That feeling triggers one’s muscle memory, training them how to react to these falls and how to better improve their balance.

“When they lose their balance, they will be able to correct their balance and not fall on the floor,” he explained. “They will be able to recover from unexpected loss of balance as if they are young people.”

Patients walk on the treadmill for 30-minute sessions twice a week for three months to see results. Without the consistent practice, however, the training can fall by the wayside within a year.

“If you don’t use it, you lose it,” he said. “Training should always be maintained … like the basic principles of exercise.”

Loss of balance isn’t a linear regression as you age. Melzer said those in their 50s may experience slight balance issues, but it is increased exponentially after the age of 60.

“After treatments of training, we saw that elderly people that conducted the training with perturbation were able to recover from balance loss better than those who just walked without any perturbations,” he noted.

However, Melzer added that just walking on the BaMPer without any jostling movements — and without anything to hold onto — still improved some balance.

Melzer developed this technology a decade ago, but it has since been sold to the Israeli company MediTouch and marketed as BalanceTutor. It is sold in several countries including Germany, Spain, China, Israel, Russia and the U.S.

The first BalanceTutor was installed in January in at Palmetto Health in South Carolina. Another is expected to be installed in the first MediTouch Clinic in Seattle in May.

The next step in his research is to add virtual reality. Patients would wear a headset that puts them in a real-life setting while on the treadmill — walking down the sidewalk or in the house.

He also recently started researching the cognitive factors of a loss of balance using an fMRI, determining if the brain looks different for people with balance problems and if there are factors that contribute to good or bad balance.

Melzer wants to expand the technology to nursing homes considering it is a rather inexpensive investment.

“It’s a very fancy treadmill,” he admitted.

In 2003, Melzer bought a $200 treadmill from a Walmart in Boston. He brought it back to Israel but after two weeks, no one wanted to use it.

“I said, ‘You know what? I’ll take it to my lab,’” he recalled. A couple BGU mechanical engineering students enhanced the treadmill with motors for the BaMPer system, which cost another $200.

“So this system, if you ask me, cost very little,” he said.

However, the system used to measure balance reactions costs about $250,000.

He recently teamed up with the Kinect system — Microsoft’s videogame tool that uses a motion sensor to interact on the screen without any intermediary device or controller — to see if that program can measure balance controls similarly for much cheaper.

“It doesn’t measure correctly, but it’s a good measure for clinical purposes,” he said.

About 60 percent of falls occur while walking, Melzer said, leaving the other 40 percent to falling out of chairs, falling due to dizziness from standing too quickly, and so on.

With the BaMPer, even 80-year-old patients recovered their balance control. Their reaction times and overall ability to recover from a fall on the BaMPer was similar to those of younger people. They overcorrected themselves from 10 to 12 steps to six to eight steps.

“If you train people, they become younger in their balance reactions,” he said. “Old people can learn new tricks.”

Contact: [email protected]; 215-832-0737

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