Martin Levesley admits, “It wasn’t something I knew anything about at all,” recalling his first meeting with Dr Bipin Bhakta from the Faculty of Medicine and Health.
“My field was aerospace,” says Martin, now Professor of Dynamics and Control in the School of Mechanical Engineering. “I’d come to Leeds to work on vibration engineering, so Bipin’s idea came completely out of the blue.”
The idea was simple: “He asked if we could build a robot which would mimic the work of a physiotherapist and help people who have suffered strokes to regain the use their arms and hands. He said ‘You’re an engineer, surely you could do this. How hard can it be?’ It was a fascinating challenge.”
It addressed a particular need for the stroke patients who Bipin – later Professor of Rehabilitation Medicine – treated at his clinics in the Leeds Teaching Hospital NHS Trust.
Connecting engineering and medicine
Martin Levesley, Engineering
Bipin Bhakta, Medicine and Health
“Typically a stroke destroys vital connections which allow us to carry out basic motor tasks,” Martin explains. “Physiotherapy is aimed at rebuilding neural pathways, so patients “re-learn” how to send signals from their brain to their hands and arms and regain the function they enjoyed before the stroke.”
Though crucial to the patients’ independence, physiotherapy on the upper limbs is not the prime focus of their treatment. Instead, the NHS – pressed for space and resources – is focused on patients’ lower limb movement, so they can be up and moving. “The focus is really on getting people out of hospital to receive their care in the community,” says Martin.
Once home, rehabilitation continues, though for their upper limb movement, stroke patients receive only short one-to-one physiotherapy sessions. While they may be prescribed an exercise regime to follow at home, patients often find this dull and repetitive.
Bipin saw robotics as the way to overcome these challenges. A device which patients could use in their own home would give them physiotherapy as frequently and for as long as they wish without the need to visit hospital; by linking the device to a computer screen the exercises could be made more stimulating and interesting.
After years of research, testing, trial – and plenty of error – Martin and his team have built MyPAM, a robotic joystick which patients can use in their own home to complement the hands-on treatment they receive from their physio.
The exercise takes the form of a computer game. The Leeds team has created a virtual world in which users tend an on-screen garden – and where the robot arm allows them to rake the lawn, sow seeds and water the plants, each of them a valuable use of their limbs. Another game is set within a rather wackier world of banana-grabbing monkeys.
Initially, the robot moves the patient’s arm by itself, but in time, as the patient gains their own strength and movement, they begin to control the robot themselves. The robot is programmed to react to how the patient is responding to the treatment to gradually offer them more and more independence of movement. The results are then sent remotely for a therapist to examine.
Trials of the device yielded promising results.
Seventeen patients were given the robot to use in their own homes over a period of six to eight weeks – and in almost every case it proved MyPAM was a success by giving them access to physiotherapy at home – as frequently and for as long as they wished. “We have clinically significant data to show that people’s upper limb movement has improved,” says Martin. Crucially, those improvements continued even after they stopped using the machines, as though the robot had catalysed further recovery in the weeks after it had been taken away. It even worked for patients who had suffered their stroke some years earlier.
This success has fired the ambition of the team to make the therapy more widely available and their plan now is to build a fleet of at least ten devices to progress to a full clinical trial. At present they cost around £5,000 each – which includes the robot arm, a computer and the official certification needed to show it is safe to be used as a medical device.
“When we started we had no idea whether this would work,” says Martin. “We’re now confident it does. There isn’t anything else out there which will recreate traditional physiotherapy.”
Sadly, Professor Bhakta did not live to see his dream reach fruition. He died in 2014, and now Martin is passionately determined to deliver on the vision of his friend and colleague: “I have 10 or 15 years left in my own career. I just want to see this happen.
“After all, to echo Bipin’s question, how hard can it be?”
Young researchers – from the very brightest undergraduates through to PhD students and post-doctoral researchers – have worked on the project, building, testing and refining the robots and creating new games.
Adam Metcalf is a former British Army vehicle mechanic, and after a tour in Afghanistan came to Leeds to study engineering with a view to working on military hardware.
But an Undergraduate Research and Leadership Scholarship changed the direction of Adam’s studies, allowing him to join the stroke research team during his summer vacation, working on the design of the robotic arms. Having graduated in July with a First, Adam is now studying for a PhD with the stroke rehabilitation engineering group, examining and comparing control strategies for MyPAM.
“I’m looking at a more complex control strategy, to determine whether the extra cost of this would translate into genuine patient benefit, especially during the early stages of their rehabilitation. My aim is to have a finished system by the end of my PhD.”
A stroke occurs when the blood supply to part of the brain is cut off, either because of a blood clot or, more rarely, because of a burst blood vessel.
Urgent treatment is essential to limit the extent of the long-term problems this can cause, and give patients the best chance of regaining their independence. Patients are often treated with medicine to reduce blood clots and relieve pressure on the brain. Sometimes surgery will be needed to treat brain swelling and reduce the risk of further bleeding.
Those who have suffered a stroke can face a range of issues, both physical and cognitive, in adjusting to living with the effects of their stroke. Strokes are the biggest cause of disability in adulthood, and for many, physiotherapy is a key part of the recovery programme.
The University’s Footsteps Fund is supporting Professor Levesley’s work to develop this technology.
Gifts to our current fundraising appeal will help the team to build more MyPAM machines for use in a full-scale clinical trial to test the benefit of this remarkable technology.
A special event on 4th March will give alumni the opportunity to meet our robotics researchers – and learn more about their work in stroke rehabilitation.
Quotes from users involved in early trials of the device show the impact it is already having on their lives:
“I am zipping up my coat using both hands, which I could not do before.”
“I am using the weak arm more in daily activities including washing up, peeling potatoes, carrying things and squeezing toothpaste.”
“The device has motivated me to do more exercises.”
“The device gave me a sense of purpose in life, something I looked forward to every day when I got up.”