Preface

Two or three decades ago, robots were considered science fiction. They performed several fantastic tasks only in the movies. Robotic technology has developed very quickly and what was once considered "science fiction" has now become reality. Nowadays robots can execute several kinds of different tasks in factories and are used to manage vital operations in hospitals. Robotic systems have evolved to such a point that they can work together with humans in factories, hospitals, and other organizations. Humans sometimes worry that in the future robots may take their jobs.

Robotic manipulators are used in both industry and medicine. In industry, robots are used for several tasks such as painting, welding, gluing, spraying, and so on. They are used in industry because they present several advantages like reduced manufacturing time, consistent accuracy, and very high product quality. Robots are also used in medicine for several purposes. Surgery and rehabilitation are two major areas in which robots are extensively employed. Surgical robots are preferred since they present better results compared to traditional methods, such as decreased blood loss, less requirement of blood transfusion, decreased rate of complications, smaller incisions, higher accuracy, and lesser recovery time. Although the history of surgical robots is very short compared to the history of surgery, thousands of surgical robots have been installed at hospitals worldwide, and hundreds of thousands of people have been treated by them. The present state of surgical robotics amazes both medical specialists and patients and therefore it is worth it to follow up with new designs and approaches of surgical robots and instruments in the future. Rehabilitation robots are especially used for assisting different types of sensorimotor functions in the arms, hands, and legs. It has been shown that patients are becoming more familiar and comfortable with rehabilitation robots as the technology presents better opportunities and devices every day. Each year several new robotic designs are developed for assisting individuals from children to the elderly. This book critically examines the development and historical evolution of medical robotics with a particular focus on urologic robotic surgery.

I would like to thank all authors who have contributed chapters with their valuable novel ideas and their knowledge on current developments about medical robotics and instruments.

**II**

**Section 5**

*and Nicolomaria Buffi*

*Tobias-Machado*

of the Vagina

*by Kwang Jin Ko and Kyu-Sung Lee*

Robot-Assisted Kidney Transplantation

Robotic Urologic Surgery **77**

**Chapter 6 79**

**Chapter 7 99**

**Chapter 8 113**

**Chapter 9 125**

Ureteropelvic Junction Obstruction: Robot-Assisted Pyeloplasty

Robotic-Assisted Inguinal Lymphadenectomy (RAIL)

*Giulio Bevilacqua, Liesbeth Desender and Alberto Breda*

*by Pietro Diana, Paolo Casale, Alberto Rosario Saita, Giovanni Lughezzani* 

*by Victor Enrique Corona-Montes, Eduardo Gonzalez-Cuenca and Marcos* 

Robotic Sacrocolpopexy for Treatment of Prolapse of the Apical Segment

*by Karel Decaestecker, Angelo Territo, Riccardo Campi, Benjamin Van Parys,* 

**Serdar Küçük, PhD** Full Professor, Kocaeli University, Technology Faculty, Department of Biomedical Engineering, Turkey

**Abdullah Erdem Canda** Professor, Koç University, Turkey

**1**

Section 1

Introduction

Section 1 Introduction

**3**

**Chapter 1**

*Serdar Kucuk*

**1. Introduction**

time, and longer lifetime.

to be shortly described.

Introductory Chapter:

Rehabilitation

Medical Robots in Surgery and

After development of the first advanced robot, they have rapidly become a part of human life. Nowadays robots are smart enough to perform a task in factories, manage an operation in hospitals, and find their way in big shopping centers. The development in automaton and robotic technology are now inevitable. In every passing day, new inventions have been made, and people have come to such a point that they work together with a robot in an organization. Even they are doubtful for a future that a robot may take their jobs. Developments in automation made medical robots enter to several fields of medicine especially surgery and rehabilitation. In the near future, a robot may be a member of hospital staff. Compared to traditional methods, medical robots serve significant advantages to the patients such as better diagnostics, smaller incision, higher accuracy, lesser infection risk, shorter healing

The development of medical robots can shortly be examined considering three progressive generations, namely, the first-generation robots (like PUMA, Scara, and Delta), second-generation robots (like AESOP), and third-generation robots (like the da Vinci Surgical System). The first-generation robots have not been designed especially for medical purposes. They have been modified for performing medical tasks. The first operation was conducted in 1985 by using PUMA 560 robot manipulator which has a surgical arm mounted on its end effector. A successful neurosurgical biopsy was performed by this manipulator. This operation encourages the robotic experts to design new-generation robots for medicine. On the contrary with the first-generation robots, the second-generation medical robots have especially been designed for medical purposes. AESOP is in the second-generation medical robots. In 1990, AESOP produced by Computer Motion was the first robotic system approved by the Food and Drug Administration (FDA) for medical operations. The third-generation robotic manipulators have been designed and manufactured after the 2000s. These robotic manipulators like the da Vinci Surgical System have been developed especially executing challenging surgical and medical operations. Although the most challenging robots have been developed for surgery operations and people in the world interested mostly in these remarkable robotic systems, robotic rehabilitation devices have also been receiving increasing attention from both medical community and patients. In this chapter, the current status and designs of robotic systems in two major fields (surgery and rehabilitation) are going

#### **Chapter 1**

## Introductory Chapter: Medical Robots in Surgery and Rehabilitation

*Serdar Kucuk*

#### **1. Introduction**

After development of the first advanced robot, they have rapidly become a part of human life. Nowadays robots are smart enough to perform a task in factories, manage an operation in hospitals, and find their way in big shopping centers. The development in automaton and robotic technology are now inevitable. In every passing day, new inventions have been made, and people have come to such a point that they work together with a robot in an organization. Even they are doubtful for a future that a robot may take their jobs. Developments in automation made medical robots enter to several fields of medicine especially surgery and rehabilitation. In the near future, a robot may be a member of hospital staff. Compared to traditional methods, medical robots serve significant advantages to the patients such as better diagnostics, smaller incision, higher accuracy, lesser infection risk, shorter healing time, and longer lifetime.

The development of medical robots can shortly be examined considering three progressive generations, namely, the first-generation robots (like PUMA, Scara, and Delta), second-generation robots (like AESOP), and third-generation robots (like the da Vinci Surgical System). The first-generation robots have not been designed especially for medical purposes. They have been modified for performing medical tasks. The first operation was conducted in 1985 by using PUMA 560 robot manipulator which has a surgical arm mounted on its end effector. A successful neurosurgical biopsy was performed by this manipulator. This operation encourages the robotic experts to design new-generation robots for medicine. On the contrary with the first-generation robots, the second-generation medical robots have especially been designed for medical purposes. AESOP is in the second-generation medical robots. In 1990, AESOP produced by Computer Motion was the first robotic system approved by the Food and Drug Administration (FDA) for medical operations. The third-generation robotic manipulators have been designed and manufactured after the 2000s. These robotic manipulators like the da Vinci Surgical System have been developed especially executing challenging surgical and medical operations. Although the most challenging robots have been developed for surgery operations and people in the world interested mostly in these remarkable robotic systems, robotic rehabilitation devices have also been receiving increasing attention from both medical community and patients. In this chapter, the current status and designs of robotic systems in two major fields (surgery and rehabilitation) are going to be shortly described.

#### **2. Medical robots in surgery**

It may not be wrong to say that the most challenging robots have been developed for surgery operations since robotic surgery (also called as robotic-assisted surgery) includes many types of dangerous procedures that can be executed with full concentration. Robotic surgery is performed in a tiny incision, and the robot must be continuously under the control of the surgeon. In general, a robotic surgical system possesses arms equipped by camera and surgical instruments and a computer console near the surgical robot or operating table. The surgeon controls each arm of the surgical robotic system by using the computer console that provides surgeon many times magnified 3D view of the operation area. In conventional surgery, surgical operations sometimes take several hours, and the surgeon performs these operations at standing position. This makes the surgeon very tired and loses the surgeon's attention. On the other hand in robotic-assisted surgery, the surgeon sits on a chair and manages other medical staff in his or her chair during the surgical operation. This prevents losing the surgeon's attention to the operation. The other advantages of robotic-assisted surgery compared to the conventional surgical operation can be summarized as follows: smaller incision, lesser pain and blood loss, lesser infection risk, and shorter healing time.

One of the most important surgical robotic systems is without a doubt the da Vinci Surgical System that has been used in millions of operation since its first approval by FDA in 2000. Until now, the da Vinci Surgical System has been used in several different types of operations such as cardiac surgery, colorectal surgery, general surgery, gynecologic surgery, head and neck surgery, thoracic surgery, and urologic surgery [1]. While performing operations with the da Vinci Surgical System, the surgeon sits in front of a console and controls the four interactive robotic arms which are used for holding objects as well as act as scalpels (a little and very sharp-bladed instrument used especially for surgery operations), scissors, and graspers. The surgeon's hand movements are translated into small actions of the instruments mentioned above inside the patient's body. One of the robotic arms holds a camera and a light source which guide the surgeon during the surgery. When the surgeon moves away his head from the console, the activities of da Vinci Surgical System suddenly are stopped. Therefore any severe problem in surgery operation is prevented. da Vinci Surgical System has also some other safety features found in [2].

#### **3. Medical robots in rehabilitation**

Rehabilitation aims to help patients retain their lost abilities back and return their healthy daily life again. Robotic rehabilitation provides patents to perform some specific exercises to gain abilities back. Rehabilitation robots are especially used for assisting different types of sensorimotor functions like arms, hands, and legs. It has been shown that patients become familiar of rehabilitation robots day by day as the technology offers better opportunities and advanced rehabilitation robotic systems. Robotic rehabilitation can be classified in two major sections, namely, upper extremity rehabilitation and lower extremity rehabilitation. There are several types of robotic systems designed and manufactured for both upper and lower extremity rehabilitation.

#### **3.1 Upper extremity robotic rehabilitation devices**

The motor functions in upper extremity parts (shoulder, elbow, or writs) can be lost from several types of events such as sports injuries, trauma, occupational injuries [3–5], cerebral palsy in childhood, and stroke in adulthood [6]. This impairment in

**5**

**4. Conclusion**

*Introductory Chapter: Medical Robots in Surgery and Rehabilitation*

**3.2 Lower extremity robotic rehabilitation devices**

body weight-supported treadmill robotic system [25].

principles of the rehabilitation methods mentioned above in detail.

upper extremity deteriorates the patient's life in many ways such as socially and economically. Therefore it is very important for patients to recover their motor functions and return to their daily life as fast as possible. The number of patients damaged from upper extremity parts is quite high. On the other hand, the number of rehabilitation therapists at the hospitals is very low at present. Therefore it is not possible for rehabilitation therapists to heal all of these patients at current situation. One more difficulty for the patients is that rehabilitation therapies are quite expensive; therefore, it is very difficult to afford. Robotic rehabilitation devices are the potential candidates to recover all of the patient's lost motor functions although they are not extensively commercial at present in the world. It may be said that the manufacturing of more and cheaper robotic rehabilitation devices is a necessity to serve all the patients.

Upper extremity robotic rehabilitation devices have been started to be developed in the beginning of the 1990s [7]. Several upper extremity robotic rehabilitation devices have been designed since the 1990s. Some important points taken into account while designing robotic rehabilitation devices can be summarized as cheap, low mass, compactness, safe operation, easy wearing, portability, and home use [8]. Some recent upper extremity robotic rehabilitation devices can be described as follows: Mit-Manus [9], Reharob [10], Armin [11], Caden-7 [12], Medarm [13], Esa human arm exoskeleton [14], L-exos [15], Armor [16], and Sarcos Master Arm [17]. As can be seen from above studies, several upper extremity robotic rehabilitation devices have been developed as prototypes in general. The number of commercialized robotic rehabilitation devices is still very low compared to the number of patients.

Lower extremity robotic rehabilitation devices can be classified as treadmill gait trainers, footplate-based gait trainers, overground gait trainers, stationary gait and ankle trainers, and active foot orthoses trainers [18]. Diaz et al. [18] summarize the

There are several lower extremity robotic rehabilitation devices that have been built until now. Some of them can be listed as follows: Alex [19], Altraco [20], Arthur [21], LokoHelp [22], Lokomat [23], Lopez [24], ReoAmbulator [25], and String-Man [26]. Although there are several lower extremity robotic rehabilitation devices developed as prototypes or for scientific research purposes, only Lokohelp [22], Lokomat [23], and ReoAmbulator [25] have been commercialized. One of the well-known commercialized lower extremity robotic rehabilitation devices LokoHelp is an electromechanical gait device and trains neurological patients with impaired walking ability [22]. LokoHelp has been tested in several training sessions, and results illustrate that LokoHelp as a robotics rehabilitation system is feasible in severely affected people having brain injury, stroke, and spinal cord injury [22]. The other well-known robot-assisted gait trainer Lokomat composes of a treadmill, a body weight support system, and a robotic gate orthosis. It helps severely impaired neurological patients. The studies illustrates that Lokomat provides effective training and high percentages of recovery potential [23]. The last commercialized lower extremity robotic rehabilitation device is ReoAmbulator that is also a

In this chapter, the designs and current status of medical robots developed for surgery and lower and upper limb rehabilitation have been described. Although the history of both surgical and rehabilitation robotic systems are very short, hundreds

*DOI: http://dx.doi.org/10.5772/intechopen.85836*

#### *Introductory Chapter: Medical Robots in Surgery and Rehabilitation DOI: http://dx.doi.org/10.5772/intechopen.85836*

*Medical Robotics - New Achievements*

**2. Medical robots in surgery**

some other safety features found in [2].

**3. Medical robots in rehabilitation**

lower extremity rehabilitation.

**3.1 Upper extremity robotic rehabilitation devices**

It may not be wrong to say that the most challenging robots have been developed for surgery operations since robotic surgery (also called as robotic-assisted surgery) includes many types of dangerous procedures that can be executed with full concentration. Robotic surgery is performed in a tiny incision, and the robot must be continuously under the control of the surgeon. In general, a robotic surgical system possesses arms equipped by camera and surgical instruments and a computer console near the surgical robot or operating table. The surgeon controls each arm of the surgical robotic system by using the computer console that provides surgeon many times magnified 3D view of the operation area. In conventional surgery, surgical operations sometimes take several hours, and the surgeon performs these operations at standing position. This makes the surgeon very tired and loses the surgeon's attention. On the other hand in robotic-assisted surgery, the surgeon sits on a chair and manages other medical staff in his or her chair during the surgical operation. This prevents losing the surgeon's attention to the operation. The other advantages of robotic-assisted surgery compared to the conventional surgical operation can be summarized as follows: smaller incision,

lesser pain and blood loss, lesser infection risk, and shorter healing time.

One of the most important surgical robotic systems is without a doubt the da Vinci Surgical System that has been used in millions of operation since its first approval by FDA in 2000. Until now, the da Vinci Surgical System has been used in several different types of operations such as cardiac surgery, colorectal surgery, general surgery, gynecologic surgery, head and neck surgery, thoracic surgery, and urologic surgery [1]. While performing operations with the da Vinci Surgical System, the surgeon sits in front of a console and controls the four interactive robotic arms which are used for holding objects as well as act as scalpels (a little and very sharp-bladed instrument used especially for surgery operations), scissors, and graspers. The surgeon's hand movements are translated into small actions of the instruments mentioned above inside the patient's body. One of the robotic arms holds a camera and a light source which guide the surgeon during the surgery. When the surgeon moves away his head from the console, the activities of da Vinci Surgical System suddenly are stopped. Therefore any severe problem in surgery operation is prevented. da Vinci Surgical System has also

Rehabilitation aims to help patients retain their lost abilities back and return their healthy daily life again. Robotic rehabilitation provides patents to perform some specific exercises to gain abilities back. Rehabilitation robots are especially used for assisting different types of sensorimotor functions like arms, hands, and legs. It has been shown that patients become familiar of rehabilitation robots day by day as the technology offers better opportunities and advanced rehabilitation robotic systems. Robotic rehabilitation can be classified in two major sections, namely, upper extremity rehabilitation and lower extremity rehabilitation. There are several types of robotic systems designed and manufactured for both upper and

The motor functions in upper extremity parts (shoulder, elbow, or writs) can be lost from several types of events such as sports injuries, trauma, occupational injuries [3–5], cerebral palsy in childhood, and stroke in adulthood [6]. This impairment in

**4**

upper extremity deteriorates the patient's life in many ways such as socially and economically. Therefore it is very important for patients to recover their motor functions and return to their daily life as fast as possible. The number of patients damaged from upper extremity parts is quite high. On the other hand, the number of rehabilitation therapists at the hospitals is very low at present. Therefore it is not possible for rehabilitation therapists to heal all of these patients at current situation. One more difficulty for the patients is that rehabilitation therapies are quite expensive; therefore, it is very difficult to afford. Robotic rehabilitation devices are the potential candidates to recover all of the patient's lost motor functions although they are not extensively commercial at present in the world. It may be said that the manufacturing of more and cheaper robotic rehabilitation devices is a necessity to serve all the patients.

Upper extremity robotic rehabilitation devices have been started to be developed in the beginning of the 1990s [7]. Several upper extremity robotic rehabilitation devices have been designed since the 1990s. Some important points taken into account while designing robotic rehabilitation devices can be summarized as cheap, low mass, compactness, safe operation, easy wearing, portability, and home use [8]. Some recent upper extremity robotic rehabilitation devices can be described as follows: Mit-Manus [9], Reharob [10], Armin [11], Caden-7 [12], Medarm [13], Esa human arm exoskeleton [14], L-exos [15], Armor [16], and Sarcos Master Arm [17]. As can be seen from above studies, several upper extremity robotic rehabilitation devices have been developed as prototypes in general. The number of commercialized robotic rehabilitation devices is still very low compared to the number of patients.

#### **3.2 Lower extremity robotic rehabilitation devices**

Lower extremity robotic rehabilitation devices can be classified as treadmill gait trainers, footplate-based gait trainers, overground gait trainers, stationary gait and ankle trainers, and active foot orthoses trainers [18]. Diaz et al. [18] summarize the principles of the rehabilitation methods mentioned above in detail.

There are several lower extremity robotic rehabilitation devices that have been built until now. Some of them can be listed as follows: Alex [19], Altraco [20], Arthur [21], LokoHelp [22], Lokomat [23], Lopez [24], ReoAmbulator [25], and String-Man [26]. Although there are several lower extremity robotic rehabilitation devices developed as prototypes or for scientific research purposes, only Lokohelp [22], Lokomat [23], and ReoAmbulator [25] have been commercialized. One of the well-known commercialized lower extremity robotic rehabilitation devices LokoHelp is an electromechanical gait device and trains neurological patients with impaired walking ability [22]. LokoHelp has been tested in several training sessions, and results illustrate that LokoHelp as a robotics rehabilitation system is feasible in severely affected people having brain injury, stroke, and spinal cord injury [22].

The other well-known robot-assisted gait trainer Lokomat composes of a treadmill, a body weight support system, and a robotic gate orthosis. It helps severely impaired neurological patients. The studies illustrates that Lokomat provides effective training and high percentages of recovery potential [23]. The last commercialized lower extremity robotic rehabilitation device is ReoAmbulator that is also a body weight-supported treadmill robotic system [25].

#### **4. Conclusion**

In this chapter, the designs and current status of medical robots developed for surgery and lower and upper limb rehabilitation have been described. Although the history of both surgical and rehabilitation robotic systems are very short, hundreds of thousands of people have been treated by these robotic systems. The present state of especially surgical robotics amazes both the medical society and the patients. On the other hand, patients become familiar of rehabilitation robots as the technology presents better opportunities like cheaper and more useful designs. Every year new robotic designs for both surgical and rehabilitation purposes are developed for individuals from children to elderly people. As a last word, it is worthy to follow up the new designs and approaches on surgical and rehabilitation robots in the future.

### **Author details**

Serdar Kucuk Kocaeli University, Turkey

\*Address all correspondence to: skucuk@kocaeli.edu.tr

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**7**

2017;**6**:3

*Introductory Chapter: Medical Robots in Surgery and Rehabilitation*

A robot-aided neuro- rehabilitation facility. Technology and Health Care.

[10] Fazekas G, Horvath M, Troznai T, Toth A. Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: A preliminary study. Journal of Rehabilitation Medicine.

[11] Nef T, Riener R. ARMin—Design of a novel arm rehabilitation robot. In: Proceedings of the 2005 IEEE 9th International Conference on Rehabilitation Robotics, Chicago, IL,

[12] Perry JC. Design and development of a 7 degree-of-freedom powered exoskeleton for the upper limb [dissertation]. University of

[13] Ball SJ, Brown IE, Scott SH. MEDARM: A rehabilitation robot with 5DOF at the shoulder complex. In: IEEE/ ASME International Conference on Advanced Intelligent Mechatronics. 2007

[14] Schiele A, Visentin G. The ESA human arm exoskeleton for space robotics telepresence. In: Conference: International Symposium on Artificial Intelligence, Robotics and Automation in Space (iSAIRAS); Nara, Japan. Vol. 7. 2003

[15] Frisoli A, Bergamasco M, Carboncini C, Carboncini C, Rossi B. Robotic assisted rehabilitation in virtual reality with the L-EXOS. Studies in Health Technology and Informatics.

[16] Mayr A, Kofler M, Saltuari L. ARMOR: An electromechanical robot for upper limb training following stroke. A prospective randomised controlled pilot study. Handchirurgie, Mikrochirurgie, Plastische Chirurgie.

2009;**145**:40-54

2008;**40**(1):66-73

1999;**7**(6):419-423

2007;**39**(7):580-582

USA. 2005. pp. 57-60

Washington; 2006

*DOI: http://dx.doi.org/10.5772/intechopen.85836*

[1] Dwivedi J, Mahgoub I. Robotic surgery - A review on recent advances in surgical robotic systems, Florida Conference on Recent Advances in Robotics, 2012. Boca Raton, Florida,

[2] Freschi C, Ferrari V, Melfi F, Ferrari M, Mosca F, Cuschieri A. Technical review of the da Vinci surgical telemanipulator. The International Journal of Medical Robotics and Computer Assisted Surgery. Dec

[3] Reid DC. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992

[5] Dodson CC, Cordasco FA. Anterior glenohumeral joint dislocations. The Orthopedic Clinics of North America.

[6] Mayetin U, Kucuk S, Sade SI. A comparative analysis of handwrist rehabilitation devices. In: 7th International Conference on Advance Technologies, April 28–May 1, Antalya,

[7] Kommu SS. Rehabilitation Robotics. Vienna, Austria: Itech Education and

[8] Islam R, Spiewak C, Rahman HM, Fareh R. A brief review on robotic exoskeletons for upper extremity rehabilitation to find the gap between research porotype and commercial type. Advances in Robotics and Automation.

[9] Krebs HI, Hogan N, Volpe BT, Aisen ML, Edelstein L, Diels C. Overview of clinical trials with MIT-MANUS:

[4] Mehta JA, Bain GI. Elbow dislocations in adults and children.

Clinics in Sports Medicine.

2004;**23**:609-627

2008;**39**:507-518

Turkey. 2018

Publishing; 2007

**References**

May 10-11, 2012

2013;**9**(4):396-406

*Introductory Chapter: Medical Robots in Surgery and Rehabilitation DOI: http://dx.doi.org/10.5772/intechopen.85836*

#### **References**

*Medical Robotics - New Achievements*

of thousands of people have been treated by these robotic systems. The present state of especially surgical robotics amazes both the medical society and the patients. On the other hand, patients become familiar of rehabilitation robots as the technology presents better opportunities like cheaper and more useful designs. Every year new robotic designs for both surgical and rehabilitation purposes are developed for individuals from children to elderly people. As a last word, it is worthy to follow up the new designs and approaches on surgical and rehabilitation robots in the future.

**6**

**Author details**

Kocaeli University, Turkey

Serdar Kucuk

provided the original work is properly cited.

\*Address all correspondence to: skucuk@kocaeli.edu.tr

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

[1] Dwivedi J, Mahgoub I. Robotic surgery - A review on recent advances in surgical robotic systems, Florida Conference on Recent Advances in Robotics, 2012. Boca Raton, Florida, May 10-11, 2012

[2] Freschi C, Ferrari V, Melfi F, Ferrari M, Mosca F, Cuschieri A. Technical review of the da Vinci surgical telemanipulator. The International Journal of Medical Robotics and Computer Assisted Surgery. Dec 2013;**9**(4):396-406

[3] Reid DC. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992

[4] Mehta JA, Bain GI. Elbow dislocations in adults and children. Clinics in Sports Medicine. 2004;**23**:609-627

[5] Dodson CC, Cordasco FA. Anterior glenohumeral joint dislocations. The Orthopedic Clinics of North America. 2008;**39**:507-518

[6] Mayetin U, Kucuk S, Sade SI. A comparative analysis of handwrist rehabilitation devices. In: 7th International Conference on Advance Technologies, April 28–May 1, Antalya, Turkey. 2018

[7] Kommu SS. Rehabilitation Robotics. Vienna, Austria: Itech Education and Publishing; 2007

[8] Islam R, Spiewak C, Rahman HM, Fareh R. A brief review on robotic exoskeletons for upper extremity rehabilitation to find the gap between research porotype and commercial type. Advances in Robotics and Automation. 2017;**6**:3

[9] Krebs HI, Hogan N, Volpe BT, Aisen ML, Edelstein L, Diels C. Overview of clinical trials with MIT-MANUS:

A robot-aided neuro- rehabilitation facility. Technology and Health Care. 1999;**7**(6):419-423

[10] Fazekas G, Horvath M, Troznai T, Toth A. Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: A preliminary study. Journal of Rehabilitation Medicine. 2007;**39**(7):580-582

[11] Nef T, Riener R. ARMin—Design of a novel arm rehabilitation robot. In: Proceedings of the 2005 IEEE 9th International Conference on Rehabilitation Robotics, Chicago, IL, USA. 2005. pp. 57-60

[12] Perry JC. Design and development of a 7 degree-of-freedom powered exoskeleton for the upper limb [dissertation]. University of Washington; 2006

[13] Ball SJ, Brown IE, Scott SH. MEDARM: A rehabilitation robot with 5DOF at the shoulder complex. In: IEEE/ ASME International Conference on Advanced Intelligent Mechatronics. 2007

[14] Schiele A, Visentin G. The ESA human arm exoskeleton for space robotics telepresence. In: Conference: International Symposium on Artificial Intelligence, Robotics and Automation in Space (iSAIRAS); Nara, Japan. Vol. 7. 2003

[15] Frisoli A, Bergamasco M, Carboncini C, Carboncini C, Rossi B. Robotic assisted rehabilitation in virtual reality with the L-EXOS. Studies in Health Technology and Informatics. 2009;**145**:40-54

[16] Mayr A, Kofler M, Saltuari L. ARMOR: An electromechanical robot for upper limb training following stroke. A prospective randomised controlled pilot study. Handchirurgie, Mikrochirurgie, Plastische Chirurgie. 2008;**40**(1):66-73

[17] Michael Mistry, Peyman Mohajerian, Stefan Schaal, An exoskeleton robot for human arm movement study, 2005 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2005). 2005

[18] Diaz I, Gil JJ, Sanchez E. Lower-limb robotic rehabilitation: Literature review and challenges. Journal of Robotics. 2011;**2011**:1-11

[19] Banala SK, Agrawal SK, Scholz JP. Active leg exoskeleton (ALEX) for gait rehabilitation of motor-impaired patients. In: Proceedings of the 10th IEEE International Conference on Rehabilitation Robotics, (ICORR '07). Noordwijk, The Netherlands; 2007. pp. 401-407

[20] Beyl P, van Damme M, van Ham R, Versluys R, Vanderborght B, Lefeber D. An exoskeleton for gait rehabilitation: Prototype design and control principle. In: Proceedings of the IEEE International Conference on Robotics and Automation, (ICRA '08). Pasadena, CA, USA; 2008. pp. 2037-2042

[21] Reinkensmeyer D, Wynne J, Harkema S. A robotic tool for studying locomotor adaptation and rehabilitation. In: Proceedings of the 2nd Joint Meeting of the IEEE Engineering in Medicine and Biology Society and the Biomedical Engineering Society. Vol. 3. 2002. pp. 2013-2353

[22] Freivogel S, Mehrholz J, Husak-Sotomayor T, Schmalohr D. Gait training with the newly developed "LokoHelp"-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study. Brain Injury. 2008;**22**(7-8):625-632

[23] Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. Journal of Rehabilitation Research and Development. 2000;**37**(6):693-700

[24] Veneman JF, Kruidhof R, Hekman EEG, Ekkelenkamp R, Van Asseldonk EHF, Van Der Kooij H. Design and evaluation of the Lopes exoskeleton robot for interactive gait rehabilitation. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2007;**15**(3):379-386

[25] West GR. Powered gait orthosis and method of utilizing same. 2004. Patent Number 6 689 075

[26] Surdilovic D, Bernhardt R. STRING-MAN: A new wire robot for gait rehabilitation. In: Proceedings of the IEEE International Conference on Robotics and Automation. Vol. 2. 2004. pp. 2031-2036

**9**

Section 2

Medical Devices
