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Neue Technologien und Robotik

New technologies and robotics

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Zusammenfassung

Immer diffizilere Computer- und Elektromotorentechnik ermöglicht den zunehmenden Einsatz und Ausbau robotergestützter Systeme in der unfallchirurgischen Rehabilitation. Die derzeit verfügbaren Devices finden jedoch selten eine flächendeckende Anwendung, sondern werden häufig im Rahmen von Pilotprojekten/-studien eingesetzt. Unterschiedliche technologische Ansätze wie u. a. „exoskeletale Systeme“, „functional electrical stimulation“, „soft robotics“, „neurobotics“ und „brain-machine interface“ werden genutzt und kombiniert, um die Kommunikation zwischen z. B. residualer Muskulatur oder Hirnströmen zu lesen, zu verarbeiten, auf das ausführende Device zu übertragen und die gewünschte Ausführung zu ermöglichen.

Die größte Evidenz besteht derzeit für exoskeletale Systeme mit unterschiedlichen Wirkmechanismen im Rahmen der Gang- und Standrehabilitation bei querschnittsgelähmten PatientInnen. Ihr Einsatz spielt aber auch eine Rolle bei der Rehabilitation hüftgelenknaher Frakturen oder endoprothetischer Versorgung. „single joint systeme“ werden ebenfalls im Rahmen der Rehabilitation funktionseingeschränkter Extremitäten, z. B. nach Knieprothesenimplantation, erprobt. An dieser Stelle ist die derzeitige Datenlage jedoch noch zu gering, um eine eindeutige Aussage über den Nutzen dieser Technologien im unfallchirurgischen „Kerngeschäft“ der Rehabilitation nach Frakturen und anderen Gelenkverletzungen treffen zu können.

Für die Rehabilitation nach Extremitätenamputation ist neben der Weiterentwicklung myoelektrischer Prothesen die derzeitige Entwicklung „fühlender“ Prothesen von hohem Interesse. Der 3D-Druck spielt bei der Herstellung individualisierter Devices ebenfalls eine Rolle.

Aufgrund des derzeitigen Fortschritts der künstlichen Intelligenz in allen Bereichen sind bahnbrechende Weiterentwicklungen und flächendeckende Anwendungsmöglichkeiten in der Rehabilitation unfallchirurgischer PatientInnen zu erwarten.

Abstract

The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.

Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery “core business” of rehabilitation after fractures and other joint injuries.

For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of “sentient” prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.

Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.

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Abbreviations

ADL:

„Activities of daily living“

AFO:

„Ankle foot orthosis“

BCI:

„Brain-computer inferface“

CARR:

„Compliant ankle rehabilitation robot“

CPM:

„Continuous passive motion“

CRPS:

„Complex regional pain syndrome“

DASH Score:

Disabilities of Arm, Shoulder and Hand Score

EMG:

Elektromyographie

FAS:

Fatigue Assessment Scale

FES:

„Functional electrical stimulation“

KI:

Künstliche Intelligenz

LEMS:

Lower Extremity Motor Scale

MPK:

Mikroprozessorgesteuerte Prothesensysteme

NMES:

„Neuromuscular electrical stimulation“

SCO:

„Stance phase control orthosis“

SHT:

Schädel-Hirn-Trauma

SR:

„Soft robotics“

SSCO:

„Stance and swing phase control orthosis“

TEPVR:

Virtual Reality

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland

    Christiane Kruppa,  Alexis Brinkemper &  Thomas A. Schildhauer

  2. BG Service- und Rehabilitationszentrum, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt am Main, Deutschland

    Sebastian Benner &  Christoph Reimertz

  3. Chirurgische Klinik und Poliklinik, Abteilung für Rückenmarkverletzte, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Deutschland

    Mirko Aach

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Correspondence to Christiane Kruppa.

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C. Kruppa, S. Benner, A. Brinkemper, M. Aach, C. Reimertz und T.A. Schildhauer geben an, dass kein Interessenkonflikt besteht.

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Kruppa, C., Benner, S., Brinkemper, A. et al. Neue Technologien und Robotik. Unfallchirurgie 126, 9–18 (2023). https://doi.org/10.1007/s00113-022-01270-0

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