Neurological rehabilitation

by | February 8, 2022

An upper limb rehabilitation robotic system allows those with stroke a chance to get continued rehabilitation in the comfort of their home.

A therapist helping a patient use Icone.

Seventy-five-year-old YC Chong had an ischaemic stroke over six years ago. An ischemic stroke, which most strokes are, happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that result in ischemic strokes.

YC started undergoing rehabilitation using an upper limb neurorehabilitation robotic system called Icone in November 2021 and has seen improvement in arm grip on his right side as well as coordination. Though he has aphasia and unable to communicate, his daughter, Melody, shared that he enjoys the daily rehabilitation and gets upset if he misses it. He uses it once a day for an hour. Previously, these robotic systems were available in hospitals and clinics but now they can be used in the comfort of one’s home and facilitate continued rehabilitation. Melody shared about her father: “He is mostly independent and goes about on his own otherwise. His stroke is diagnosed as moderate due to his speech loss else he seems normal.” She shared that besides using Icone, YC also goes to the gym and works out with light weights with a personal trainer.

Ageless Online finds out more about Icone from Maria Teresa Francomano, co-founder and executive director of Heaxel, who brought in Icone to Singapore:


How does Icone work for someone with stoke like YC?

Icone is the first upper limb neurorehabilitation robotic system cleared for hospital and home use. lt engages and motivates patients via interactive, personalised exergames, proposing planar reaching tasks, and performance feedback. Icone supports clinicians in tailoring and delivering intensive rehabilitation treatments, and provides a quantitative assessment of motor recovery.


What are the criteria/requirement for someone with stroke to be able to use it?

To benefit from robotic neurorehabilitation, there are certain clinical evaluation criteria that the patient has to fulfil. An initial evaluation is performed by clinicians to assess if requirements are met.


Is it only to help the upper limb? What about the rest of the body?

Yes, the Icone is for the upper limb rehabilitation. Currently, Heaxel is working to provide more technical solutions in order to enlarge the rehabilitation offer.


Besides those with stroke, what other patients who are 60 and above can also benefit from this robot-assisted rehabilitation?

Besides stroke, this kind of robot-assisted rehabilitation can be beneficial for other neurological conditions like head injury, cerebral palsy, peripheral nerve injury, etc.


Why is neurorehabilitation so important?

Neurological rehabilitation is aimed at optimising the level of function of the patients with motor impairment, within their usual environment. This includes maximising physical ability, preventing deterioration due to secondary disease, optimising the patient’s environment, facilitating psychological adaptation to disability and encouraging social integration. In simpler terms, neurological rehabilitation can often improve function, reduce symptoms, and improve the well-being of the patient.


How many people in Singapore are currently using this robot? For mostly what conditions?

Currently we have two patients using the Icone robot in Singapore, including YC. They are using the robot at their respective residential addresses. Both the patients are chronic stroke patients (meaning they had their stroke a few years ago), with impairments to right upper limb in combination with other effects.


If there wasn’t a robot available, what normally would stroke patients have to do for their neurorehabilitation?

Stroke and other neurological patients have to visit physiotherapy centres or clinics to continue their rehabilitation. Otherwise, they could also request neurorehabilitation at home with the trainer visiting the patient. In both the scenarios, the physiotherapist makes the patient undergo certain exercises.

Scientific studies have demonstrated that a stroke disabled patient can recover motor functionality long after the stroke event itself, even up to the end of life, but this would require an intensive long-term rehabilitation treatment that can be more effectively provided by robots. Furthermore, the COVID-19 situation has created severe logistic issues in terms of limits to the number of people allowed to visit and social distancing.


What is the cost of having this robot? Do patients have to go through their doctors to get it?

There is different pricing for accessing Icone robots at rehabilitation clinics and physio centres compared to renting Icone. The price for renting also depends on whether an individual or an organisation request for it. We are also working on other models for providing access to patients for continued, intensive rehabilitation. Overall, we are quite flexible with the pricing and our goal is to make robot-assisted rehabilitation available to a maximum number of people who need it.

Patients do not necessarily have to come through a doctor or therapist to gain access to Icone. For patients who do not have their personal therapist or doctor, we have a provision of providing medical support and feedback through our partner physiotherapist.


How long would someone need this neurorehabilitation for?

Neurorehabilitation, like any other rehabilitation, is a continuous thing. For undergoing rehabilitation with Icone, we suggest a three- or six-month intensive therapy in the first year, followed by a two-month intensive therapy in the following years.


Where do you see the future of neurorehabilitation and the use of technology?

Robot-assisted rehabilitation is an exciting technology and has taken a front seat in the last couple of decades. These robotic rehabilitation devices are slowly making their way into hospitals and medical centres owing to their operational efficiency and output efficacy. However, there are considerations like size, form factor, safety and cost to be taken into account when bringing these technologies to be used at home.

At Heaxel, we have managed to overcome these challenges and came out with Icone to make robot-assisted rehabilitation available for out-of-hospital use. This is extremely necessary to continue intensive rehabilitation therapies for the patients, which they otherwise are not able to do after getting discharged from the hospital.

The future of rehabilitation lies in getting affordable robotic technologies to a maximum number of people. Use of technology will allow clinicians and therapists to monitor and deliver therapy to a larger group of patients. The current pandemic has created logistical concerns for both patients and clinicians, and technology like Icone can overcome these concerns.




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