Every step is like a clumsy kiss
(ChinaIT.com News) For a long time, spinal cord injury was considered irreversible in science.The central nerves that grow in the human spine do not recover after injury.The loss of human function is like a broken circuit that can no longer transmit information.However, research in the 1990s found that repeated stepping actions can allow the “power-off” spinal cord to regain control of movement.
In 2003, Shuai Mei, a postdoctoral fellow in the Department of Precision Instruments at Tsinghua University, started academic research on “humanoid robots”.Six years later, on the basis of the previous, she turned her research goal to the lower extremity exoskeleton robot.In 2016, she founded Dayai. The exoskeleton robot produced by it has been used in clinical trials and has shown obvious effects on patients with cerebral palsy and paraplegia
In November of this year, I experienced exoskeleton lower limbs in Dayai.
01
“15 years is not as good as these 5 days”
Using the knee as the dividing point, I was measured for the length of my calf and thigh. The seat-like equipment was adjusted, and I sat in, and my feet, knees, thighs, waist, and shoulders were all secured by straps. As the body was pulled by the machine to stand up a little bit, I was a little excited, so that the human body can walk in symbiosis with the exoskeleton and lower limbs.
Dayai Company, located in Daxing District, Beijing, is also a rehabilitation training base. On the lower floor of the office area, the ground is divided into several areas by stickers. A dozen exoskeleton robots are placed against the wall, and patients come here for training every day.
For me, trying on these exoskeleton robots is a “privilege.” Their function is to help people who are paralyzed or have difficulty walking to recover their lower limbs.
“The center of gravity may lean forward when you land, don’t be afraid.” Xiao Man, who has been with me, said to me. She is an intern of Da Ai. When accompanying other paralyzed people for the first trial, she always ordered this way, but I was a little redundant.
From the waist down, it looks like being entangled by trees and vines, and it is also like being held by a giant. The center of gravity is slightly swaying. I can hardly notice it. However, for patients who are bedridden for a long time, they are likely to have orthostatic hypotension when they stand up. .
Standing is an instinct in human genes, and so is walking. When I use the boost mode, the machine is 60% powerful, and the remaining 40% is on my own. Every time I stepped hard and hit the ground, the joy of the soles of my feet came like instinct, looking forward to the next step. Every step is like a clumsy kiss.
Try on Daai Robot | Geek Park Live Shooting
“I have not lived as good as these 5 days in the past 15 years.” Daai Robot CEO Shuai Mei remembers clearly that in 2018, the 15-year-old girl An Qi said this to her. At that time, An Qi chose to take a leave of absence in the second semester of high school, and had time to come to the company for intensive training. Surprisingly, after only 5 days of training, she can walk autonomously on crutches wearing a lower limb robot.
“The college entrance examination is really difficult for me, and even if I pass it, my physical condition does not allow me to take it.” Because the brain motor area is underdeveloped, writing is not so easy for her. It is a challenge to write the test paper by hand within the prescribed time. Now An Qi is 19 years old. When chatting, she proudly showed me a neatly handwritten notebook. When she first learned to write, it took her 40 minutes to write a handwriting.
The mother compared her daughter’s state as “brain cells cannot control the parts of the body.” Because cerebral palsy was diagnosed only half a month after birth, there was no early intervention. When he was one or two years old, the doctor’s hope for An Qi was only that he could sit up and clasp his hands together in the future. The family has been working hard to recover, but there is no training method that can teach her to walk. About 7 years ago, she tried to use crutches once in the rehabilitation center. She couldn’t stand at all and fell backward. “Then everyone knew that Angie couldn’t. I never used crutches again.”
It was the robot who started to teach her how to use her legs. The Aidong robot that let her experience “walking independently” weighs about 20 kilograms. There are some differences from the exoskeleton I wear. There is only a titanium alloy bone frame for the waist and legs, and there is no peripheral support for standing.
An Qi first tried to train with a frame-assisted exoskeleton. Da Ai Robot CEO Shuai Mei saw that An Qi was in good condition and suggested that she try another one and walk on crutches.
When the exoskeleton robot was first developed, Shuaimei did not imagine that it could help patients with “cerebral palsy” like An Qi. An Qi never imagined that she would be able to get rid of a wheelchair for the rest of her life. Now, she is able to walk with elbow crutches. Her biggest wish is to continue to get rid of crutches. With one more hand, she can take better care of herself.
Exoskeleton robot Ai Kang (left), Ai Dong (right) | Source: Da Ai Robot
02
The machine learns from the human, and then teaches the human
For Shuaimei, the development of exoskeleton robots can be traced back to her as a postdoctoral fellow in Tsinghua Precision Instrument Department in 2003. In the beginning, her research direction was “humanoid robot” (humanoid robot).
At that time she was studying how to make robots imitate human walking. She recalled to me that the “China’s first humanoid robot walking on rugged roads” made by her team back then randomly sprinkled a handful of obstacles ranging from 5 mm to 2 in height, and the small robot could surpass it. The obstacle walks over without falling down. “This also laid the foundation for all technologies.”
For people, if they suddenly encounter a bump under their feet, they will react to conditioned reflexes, and even instantly adjust their center of gravity to avoid falling. This comes from the instinct of self-protection. It is not easy for robots to acquire such “instinct”. The strategy of Shuaimei’s team is to calculate the force on the soles of the feet through algorithms, and then adjust the gait of the legs and torso accordingly.
Schematic diagram of the five-axis humanoid robot system in a paper published by Shuai Mei in 2006 | Source: IEEE
At that time, humanoid robots were a cutting-edge academic field, and Shuai Mei hopes to make technologies that can be applied in practice. The “exoskeleton robot” used as a medical device has become a suitable choice. When initially designed, her goal was to make a robot that helps the elderly and hemiplegic patients recover their walking function.
Perhaps she has studied gait, which made her more sensitive to people’s walking posture. When talking, Shuai Mei got up from the chair from time to time, imitating various walking postures. The soles of her feet were close to the ground, her left and right feet were close together, and she moved forward with each other-once in an underground passage, she saw an old man walking in this posture, “I was thinking, when people grow old, if they are all like this In a state, life will be very sad.” On the campus of Beihang University, she often sees retired teachers who have difficulty walking, and her mother is getting older and her legs and feet are gradually inconvenient.
Based on the technological accumulation of humanoid robots, the research on the gait research, control method and mechanism design of the exoskeleton lower limbs is also a logical step in the technical path. So around 2009, she turned her research goal to lower extremity exoskeleton robots. In 2016, Dayai Company was established and began industrial operations. In clinical trials, she found that lower limb robots have obvious effects on patients with cerebral palsy and paraplegia.
One year later, in 2017, Shao Haipeng put on the Daai robot for the first time in Beijing. “Sitting to see the world and standing to see the world are two worlds.”
More than half a year ago, he fell from a height of 17 meters while doing electric welding work, his seat belt broke, and the 11th and 12th vertebrae from the waist to the chest suffered fractures. Since then, he has become a paraplegic patient. He has no sensation two or three inches below his belly button. He has never stood up “naturally” after that. When the robot is taken forward, he still has no sensation on his legs. But he felt that “just like walking by himself, he closed his eyes and walked forward.”
Without perception, the brain cannot command the legs. When doing physical therapy, the rehabilitation therapist lifted his legs and asked him to use “mind” to imagine that his legs could be lifted-Shao Haipeng still has memories of the state of walking before the paraplegia, but he has never walked with his legs. For An Qi, finding a standing posture requires the assistance of two people, one holding the waist and the other holding the legs.
“Many people have some misunderstandings, thinking that to make an exoskeleton, as long as the person can stand up and walk a few steps, the problem will be completely solved.” Shuai Mei explained to me that ordinary people have the ability to balance autonomously, while exoskeletons are The patient should be taught to balance in the dynamics of walking. Due to technological innovation and clinical efficacy verification, Daai Robotics obtained China’s first CFDA registration certificate for exoskeleton robots in 2018 (this means that medical devices can enter the market as products).
For a long time in the past, spinal cord injury was considered irreversible in science. The central nerves that grow in the human spine do not recover after injury. The loss of human function is like a broken circuit that can no longer transmit information. However, research in the 1990s found that repeated stepping actions can allow the “power-off” spinal cord to regain control of movement.
This is different from the brain transmitting signals through the central nervous system to control movement. It is more like a circuit that is passively trained through external stimuli. “Passive robots are used to walk and input signals to the body. The growth of cells is local.” Chen Sijing, a rehabilitation physician at a tertiary hospital, explained to Geek Park.
At least for now, scientists have discovered that spinal cord circuits have certain “plasticity” and can trigger certain functions. However, central nervous system damage is still a world-class academic problem. For those patients who live with “academic problems”, they want to use training to solve small and specific problems: for example, you can stand up again when you squat down, and you can stand for a while when you let go of crutches.
03
“1 mm per day”
In the spring of 2019, 16-year-old An Qi wants to get out of the house.
Through the exoskeleton robot, her legs have learned the walking posture. She wants to try to explore the world with her legs without the help of a “machine trainer”-the goal is outside the courtyard of the community and the shopping mall across the eight-lane road. Ice cream shop. This mother takes 15 minutes to walk every day. She has walked for 4 hours, but this is her first time to “independently” walk. When she got up the next day, she saw a pigeon-egg swelling on her elbow. The exhaustion of elbow crutches yesterday made her get tenosynovitis.
But she couldn’t forget the sweetness of ice cream in that spring. Now she takes the same route, from home to the mall, it only takes 40 minutes.
“Sister, when you go to run a marathon, the strength you used to run out of breath may be equivalent to a small step for me.” An Qi said to me.
An Qi with elbow crutches | Source: Interviewee
At the end of this year, Mr. Wang, who was paralyzed in a wheelchair for 8 years, used the Daai robot on Douyin, so he rented one for training at home. He recovered the feeling of having his legs and was able to turn himself over in the middle of the night. The legs began to grow muscles, and the skin that had been wrinkled “like plastic skin” due to muscle atrophy began to regain its elasticity. When talking to me, he patted his thighs, “Now I feel like taking pictures here.” Using the strength of his thighs, he can lift his calves slightly.
According to the usual medical judgment, the best recovery period after paralysis is within six months. From this point of view, Shao Haipeng is much luckier than Mr. Wang. He encountered the Daai robot after just 6 months of paralysis. In his 20s, he insisted on training and recovered quickly. In 2018, he wore a robot to finish the whole marathon in 9 days. In those nights, all kinds of pain caused him to lose sleep, and the sweat dripped on the bed to form a ” “Da”, but the perception of the lower body spreads down every day. This feeling lasted until a period of time after the marathon. “You can feel it with your hands, and you will move a finger or two down every one or two days.”
Now, Shao Haipeng can squat down with elbow crutches and stand up by himself, which means greater freedom: if you are tired from going out and walking, you can stop to rest and continue walking. He wanted to do one thing: to travel around China by bicycle, to the Disabled Persons’ Federation in each place, to stay for a few days to exchange rehabilitation experience with people. To really realize this wish requires at least a sum of money and a durable car. He is currently building a “recumbent car” manually at home.
Schematic diagram of the “lying car” Shao Haipeng wants to use to travel around China | Source: Interviewee
Even after five or six years of paralysis, he can slowly improve through training. Chen Sijing introduced to Geek Park, “In the past, I might feel that the course of the disease was two to three years, and the shape was almost finalized.” Working in a rehabilitation hospital, she has the opportunity to observe that some patients are gradually recovering in the span of five or six years, or even ten years.
In the process of seeking medical treatment, an expert from a rehabilitation hospital said to Mr. Wang: Maybe you are recovering every day. Assuming that the nervous system is 1000 meters, you may only recover 1 mm every day, but the speed is slow.
Paralysis of the lower limbs will bring about a series of “disuse syndrome”. Abnormal bodily functions will first affect the urinary system. Accumulation over time will lead to urinary stones and gastrointestinal diseases. Muscle atrophy and nerve pain are also accompanied by left and right. There was a patient who had been in rehabilitation training. He trained with him during the day and committed suicide in the middle of the night. “It must be so painful that the heart can’t stand it.” He also experienced nerve pain for a full 24 hours, and his body had already developed painkillers. Resistance can only be passed by will.
Now, he felt the power of believing. It’s like fighting with a sword and suddenly discovering a tank, “If the inner hope was 10% before, now it is 70%.” He keeps an eye on the latest technological developments on the Internet from time to time, hoping that one day he can return to being like ordinary people.
In the view of rehabilitation physicians, the lower limb robot is a tool that can produce very good results, but more importantly, how the rehabilitation physician uses it requires a treatment plan suitable for the patient. If you want to obtain long-term accumulated curative effects, the duration, frequency, and boost parameters of each use are different. The plan needs to be different from person to person. For example, some patients can barely walk, but one leg is not straight. This requires doctors to explore how to use them flexibly and cooperate with other training.
At an exhibition in 2018, Ms. Mary Ellen Buning, the chairman of the North American Association of Rehabilitation Engineering and Assistive Devices, had a conversation with Shuai Mei for an hour in front of Da Ai’s booth. Mary is a high-level paraplegia patient. She told Shuai Mei that she hoped that Daai’s products could help the paralyzed population in the United States.
Exoskeleton robots existed in the United States for a long time, and products like Rewalk have been commercialized. Unlike the Daai robot, it is suitable for people who can barely stand up, and those with inconvenient mobility can move freely after wearing it. Such a product can hardly help a person with weak lower limbs to stand up. “It adapts to a relatively narrow patient type.” Shuai Mei explained.
Chen Sijing introduced from the perspective of rehabilitation training that when the patient has basic mobility and sufficient strength, but cannot control the movement well, he needs to correct the movement in more detail. The most supportive exoskeleton she has used in this regard is Keeogo from Canada. This exoskeleton can calculate the angle and force of joints in real time when going up and down stairs, and apply external intervention and guidance through algorithms.
Exoskeleton of Rewalk (left) and Keeogo (right)
When leaving Da Ai, Xiao Man sent me out. She majored in rehabilitation and would like to stay and work here after graduation. During the small chat, she told me that the reason for choosing this major was related to the family’s congenital disability. It’s just that the current technology can’t effectively solve the problems faced by her family.
We fell into silence for a while.
However, “small” improvements can make her satisfied at work. She taught the patients how to use the robot. “One patient has been paralyzed for 18 years. The perception of his lower limbs is recovering, and his strength has been developed a little bit. He is confident that he can stand up one day.” Seeing them stand up, “I will also be happy. “.
(At the request of the interviewee, Xiao Man is a pseudonym.)
Editor’s note
If the Internet 20 years ago was a baby in a swaddle, after the rapid development, the Internet of science and technology has become a muscular young man-people from yearning, hope, vigilance, and even fear of its immense power-technology in addition to The happy running is transforming the old world and ushering in an era when we need to take more responsibility for the new world.
Technology shouldn’t just be a consumer product that creates a black hole of time with precise push again and again, and its mission should not be an infinite “growth game” and “fishing and fishing” of user data, but should return to the “people” themselves.
Geek Park not only pays attention to “new technology”, but also pays attention to “Tech with Heart”-Tech with Heart
We have found some teams and people who are using technological means and innovative methods to create a higher “ROI” for society.
This is the ninth chapter planned by “Heart Technology”.
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