Rehabilitation and Health Care Robotics 53.7 Conclusions and Further Readings 1245 parallel actuator system that requires only the small, Beyond safety.there are other ethical concerns that fast actuator to be carried in the arm,leaving the slow will emerge as robotics technology becomes more in- energy-storage system on the base and not contributing telligent with advances in cognitive software,more to the inertia of the arm itself,can lead to a 1:1 payload- invasive with nanotechnologies,and better integrated to-weight ratio that is more in line with a human's own with human systems through bioengineering advances. arm characteristics,and thereby provides a safe yet high- Ethicists and roboticists are starting to deal with these is- performance solution.An added benefit of this type of sues [53.153,154],which to date have been the purview arrangement is that the movements of the arm will tend of only futurists and science fiction writers.Chap- to be more human-like,providing a measure of confi-ter 64 in this Handbook deals with these issues in dence to the user that the robot is performing properly detail. and moving in a safe way. An economic advantage has not yet been demon- Strategies for improving safety have been proposed strated in a decisive way for most rehabilitation robotics and methods to assess safety have been developed and For example,the therapeutic benefits conferred by adapted for rehabilitation robotics [53.151,152]based robotic therapy devices,and the assistive benefits con- on accepted risk analysis methods.While industrial ferred by wheelchair-mounted robots relative to the robots have benefited from International Organization device cost,have not yet been large enough to cause for Standardization (ISO)user safety regulations since widespread adoption.Improvements in their efficacy and 1992 (ISO 10218),the fundamental issue of human reductions in their cost will increase their usage.For ex- proximity to robots for the personal,service,and re-ample,arobotic therapy device that helps people learn to habilitation sectors have prevented any consensus to walk after a stroke in a way that is decisively better than date for a similar standard.Currently,the existing indus-other training techniques would become widely used art trial standards,augmented with provisions from medical very quickly.Likewise,a wheelchair-mounted robot that m equipment standards and buttressed by engineering best gives a disabled person a substantial and efficient in- practices and adherence to professional codes of ethics crease in autonomy at a reasonable cost would also by designers,have guided rehabilitation robotics design-quickly become widely used.An example of a robotics ers.Clearly,as products appear on the market and the technology that has achieved an attractive cost-benefit expected rapid expansion of this sector happens,better ratio and thus is commercially successful is the powered regulations must be developed. wheelchair. 53.7 Conclusions and Further Readings Rehabilitation robotics is a dynamic application area multilevel software architecture.The grand challenges because its grand challenges are at the forefront of therefore span the domains of electromechanical design, both robotics and biology research.The ongoing major software design,and,due to the applied and innately themes of the field can be summarized as the develop- human-focused nature of rehabilitation robotics.all ment of robotic therapy devices,smart prostheses,or- aspects of user interface design,including physical, thoses.functional aids.and nurses that match or exceed communication,learning,emotional,and motivational the capabilities of their human counterparts.Rehabilita- factors.The first products in this field have come on tion robotics is also a highly motivating field because the the market in only the last ten years;worldwide de- technology developed will directly help people who are mographic trends will provide the force to accelerate limited in major life activities.The field will continue to product development in the future. grow because of the dramatic aging of the populations For further investigation on rehabilitation robotics, of industrialized countries that is just beginning. there are three major sources of published informa- The grand challenges of rehabilitation robotics are tion:(1)books on personal,service,and rehabilitation grounded in the distinguishing features of the field: robotics such as [53.155-157];(2)review articles in functional involvement with humans,a physical user journals and periodicals such as [53.158-161];and interface,and behavior that is intelligent,adaptive,(3)articles that deal with individual topics,such as and safe.These characteristics require high levels of those in the reference list below,and conferences redundancy.sensorimotor capability,adaptability.and such as the International Conference on RehabilitationRehabilitation and Health Care Robotics 53.7 Conclusions and Further Readings 1245 parallel actuator system that requires only the small, fast actuator to be carried in the arm, leaving the slow energy-storage system on the base and not contributing to the inertia of the arm itself, can lead to a 1:1 payload￾to-weight ratio that is more in line with a human’s own arm characteristics, and thereby provides a safe yet high￾performance solution. An added benefit of this type of arrangement is that the movements of the arm will tend to be more human-like, providing a measure of confi- dence to the user that the robot is performing properly and moving in a safe way. Strategies for improving safety have been proposed and methods to assess safety have been developed and adapted for rehabilitation robotics [53.151, 152] based on accepted risk analysis methods. While industrial robots have benefited from International Organization for Standardization (ISO) user safety regulations since 1992 (ISO 10218), the fundamental issue of human proximity to robots for the personal, service, and re￾habilitation sectors have prevented any consensus to date for a similar standard. Currently, the existing indus￾trial standards, augmented with provisions from medical equipment standards and buttressed by engineering best practices and adherence to professional codes of ethics by designers, have guided rehabilitation robotics design￾ers. Clearly, as products appear on the market and the expected rapid expansion of this sector happens, better regulations must be developed. Beyond safety, there are other ethical concerns that will emerge as robotics technology becomes more in￾telligent with advances in cognitive software, more invasive with nanotechnologies, and better integrated with human systems through bioengineering advances. Ethicists and roboticists are starting to deal with these is￾sues [53.153,154], which to date have been the purview of only futurists and science fiction writers. Chap￾ter 64 in this Handbook deals with these issues in detail. An economic advantage has not yet been demon￾strated in a decisive way for most rehabilitation robotics. For example, the therapeutic benefits conferred by robotic therapy devices, and the assistive benefits con￾ferred by wheelchair-mounted robots relative to the device cost, have not yet been large enough to cause widespread adoption. Improvements in their efficacy and reductions in their cost will increase their usage. For ex￾ample, a robotic therapy device that helps people learn to walk after a stroke in a way that is decisively better than other training techniques would become widely used very quickly. Likewise, a wheelchair-mounted robot that gives a disabled person a substantial and efficient in￾crease in autonomy at a reasonable cost would also quickly become widely used. An example of a robotics technology that has achieved an attractive cost–benefit ratio and thus is commercially successful is the powered wheelchair. 53.7 Conclusions and Further Readings Rehabilitation robotics is a dynamic application area because its grand challenges are at the forefront of both robotics and biology research. The ongoing major themes of the field can be summarized as the develop￾ment of robotic therapy devices, smart prostheses, or￾thoses, functional aids, and nurses that match or exceed the capabilities of their human counterparts. Rehabilita￾tion robotics is also a highly motivating field because the technology developed will directly help people who are limited in major life activities. The field will continue to grow because of the dramatic aging of the populations of industrialized countries that is just beginning. The grand challenges of rehabilitation robotics are grounded in the distinguishing features of the field: functional involvement with humans, a physical user interface, and behavior that is intelligent, adaptive, and safe. These characteristics require high levels of redundancy, sensorimotor capability, adaptability, and multilevel software architecture. The grand challenges therefore span the domains of electromechanical design, software design, and, due to the applied and innately human-focused nature of rehabilitation robotics, all aspects of user interface design, including physical, communication, learning, emotional, and motivational factors. The first products in this field have come on the market in only the last ten years; worldwide de￾mographic trends will provide the force to accelerate product development in the future. For further investigation on rehabilitation robotics, there are three major sources of published informa￾tion: (1) books on personal, service, and rehabilitation robotics such as [53.155–157]; (2) review articles in journals and periodicals such as [53.158–161]; and (3) articles that deal with individual topics, such as those in the reference list below, and conferences such as the International Conference on Rehabilitation Part F 53.7