Last week, leading experts in neurorehabilitation gathered at the Center for Clinical Neuroscience of Hospital Los Madroños in Madrid for the event: “Innovation in Neurorehabilitation Technology: Academic and Clinical Perspectives.” Our consultant researcher bioengineer, Eleonora Guanziroli, was also present to deliver a lecture* on the interaction between individuals and machines. This is a short excerpt.

✔ Usually, in Rehabilitation Medicine, both the phases before and after a treatment are assessed. Nevertheless, no one focuses on what happens in between, during the treatment itself. No one wonders: “Is the patient fully engaged in the therapy?”.

✔ We are discussing two types of interactions. First, a motor interaction that occurs – for instance – when an exoskeleton is used in an exercise. In this scenario, the robot applies a force to the patient, which is expected to initiate a reciprocal exchange of forces between the individual and the machine. Is it really happening, and are the muscles activated with correct timing? To determine this, the biomarker that we need to detect is the electromyographic response.

✔ The second is a cognitive interaction. Is the patient truly present with his mind, thoughts, and intentions? In this case, the more interesting biomarker is the heart rate variability, which is linked to cognitive flexibility. If the heart rate is too low, it means the individual is not very responsive.

✔ By assessing these two parameters, the electromyographic signals and the heart rate variability, we can fine-tune the machine, whether it is an exoskeleton or another robotic apparatus, to the specific needs of the patient. The ultimate goal is always the same: to find the setting that allows for achieving the highest level of central neuromodulation and the most effective recovery of plasticity.