If I were to say “Arena Sports” – what sport would come to mind? Basketball? Indoor soccer? Dwayne “The Rock” Johnson’s return to WWE? Now, would I do that to you? Ok, I probably would, but I’m not going to… today. I was thinking more along the lines of the second running of Cybathlon. You know the event. The one with the disabled athletes competing in powered wheelchair races, the FES bike race, powered prostheses races – even exoskeleton and BCI races. The one with the YouTube videos that are a cross between Rocky Balboa’s triumphant stair climb and the “Chariots of Fire” beach run that unfailingly make you tear up with joy and hope for the human race. Cybathlon 2020 returns to Zurich May 2-3; two of the six races are full and the remaining four races are expected to reach capacity as well. But how exactly did this perfect storm of robotics and engineering, human fortitude, and creativity become an international juggernaut?
In much of the published information about Cybathlon, initiator Robert Riener says that its genesis sprang from a desire to foster the relationship between the end users of robotic assistive devices and the researchers creating the devices in order to get meaningful and functional results. But in talking to Dr. Riener, I discovered the precise moment the idea came to him.
In November of 2012, Zac Vawter climbed the 103 stories of Chicago’s Willis Tower. As exhausting as that sounds, let’s add to that ten extra pounds of a robotic leg, the burden of publicly trialing an $8 million research investment, as well as the eyes of the world, and the entire adventure takes on an entirely new set of pressures. While Zac broke records that day and certainly inspired an entire population of amputees, paralyzed people, and their families, he also served as the inspiration for the Cybathlon.
Riener was on vacation when he read about Zac’s record-breaking accomplishment. “I thought, ‘Wow! Why not organize something like this in Switzerland? Why not do it in a stadium? Why not add many disciplines?’”
Each Cybathlon team includes a pilot from the very beginning. Keeping the end-user at the center of the design process helps to ensure an optimal feature set and informs the engineering and design teams what the population needs most – not what the engineers suppose is most needed.
“I know that many scientists often approach their research problems without checking out their users’ needs. They think they know the answer to the problem without ever talking to the patient or the person with a disability or without talking to the medical staff,” said Riener. Then, they wonder why their idea isn’t being accepted. People need to talk. That was one of the motivations behind Cybathlon – where we bring these people together very early.
“We meet with many different stakeholders. We’re meeting with patients and other people with disabilities to get their feedback in organizing the event,” Riener continued. “We take care of this mix of users, developers, different parties, so that we get results that are meaningful and functioning for those who need the devices.”
The Cybathlon is a fully developed event and I was inspired by Roland Sigrist's comment on why he is involved as the organization's executive director. "Inclusion is the freedom to choose," he said. "the Cybathlon promotes this by connecting people through a unique competition that stimulates the development of assistive technologies."
As compelling as Cybathlon is, Riener’s day job is Professor, Sensory Motor Systems at the Department of Health Sciences, ETH Zurich. He developed the award-winning ARMin robot and his lab focuses on rehab robotics, human motion synthesis, biomechanics, man-machine interaction and virtual reality. I spoke with him at some length regarding the possibilities and potentials for “closing the loop” as a means to improve the usability of prosthesis and robotics.
JP: “Your work incorporates AR/VR and making the user’s experience a whole-body event. You’re also working to close the loop between the robot, therapist, and the patient. Where do you see other opportunities for closed loop systems?”
RR: “There are many examples where you can achieve much more by closing the loop. Most prosthesis are passive and even the active ones only have a motor. The motor needs to be integrated in a closed loop so that the motor knows what to do. The user needs to get feedback as well, but the feedback is lost because the user lost the limb. They need sensory afferent feedback and that can be done with technical support. You can stimulate the skin tactilely to give them proprioception of the force on the foot, for example, or the finger forces when grasping an object. It is important to enable the user to grasp an object with the right amount of force without dropping the object or damaging it. You must close the loop to do that.”
JP: “Where do you see closed loop systems in ten years? Where would you like to see it go?
RR: “It is difficult to make predictions. Even after ten years we are still far away from natural body functions. Of course, the single solutions – when a prosthesis gets powerful enough to jump – but only to jump, will be important but will not be enough. To get machines that enable us to perform very broad functions – as we can do with our natural limbs and body, we are still far away and even if the developments are getting better and better, there are clear limitations in computers, in machines, in motors, which are hard to remove unless we develop biological systems. There’s a large potential there. If we have a biological system, then we can probably get much closer to our performance of our biological body.”
JP: “Do you see an opportunity to close the loop in your own work in robotics with neural sensing technologies?”
RR: “For sure! I think it’s important to combine these systems. Connecting BCI with machines is already being done. But the detection of brain signals using brain recordings and measurements is very difficult and limited. Using large electrodes on the scalp will never make it. We have such a high resolution of signals; millions of neurons need to be active just to make one decision. We don’t get to this resolution using large electrodes outside the brain. Implanted is much better.”
The promise and opportunity for closed loop devices intrigued me so I asked another expert on the topic where he thought closed loop technologies could help to advance not only Dr. Riener’s work, but the neurotech field as a whole. “Improving the quality of the recorded brain signals was our motivation to develop an implantable closed loop system,” explained Joern Rickert, CEO of CorTec. “With our Brain Interchange technology, we have the ability to wirelessly measure and stimulate on 32 channels, which hitherto has not been possible with any system on the market. We see in the field that there is a need for a further increase in the number of channels for many applications. Therefore, we are already working on boosting the channels for future generations of our system. In order to provide reliable solutions for the patients, we also take intensive care of the long-term stability of electrode interfaces and the recorded signals.”
Riener’s use of a closed loop system is not limited to a purely technological use of the term. The robotic rehab devices that he develops are also meant to close the loop between the patient, the therapist, and the robot. The ARMin, for example was designed to be transparent to both the patient and the therapist, but to augment them both – each one working in a connected way with the other.
“We tried to fuse the human therapist with the robot. In this way we are fusing the advantages of both to one unit,” said Riener in his 2018 TEDx Talk. “The robot is very strong, it has endurance, it can do the training with the patients for hours. That’s good. The therapist in contrast has the experience, the fine motor skill, the feeling, she can touch the arm of the patient and move the arm of the patient with the patient. In this new strategy, the therapist is moving the robot together with the patient arm, but she does not feel the robot, she feels the patient arm. The robot can detect the activity and the tension of the therapist – but the robot stays mechanically transparent.”
Riener is also closing the loop across the research community by including everyone that has a stake in the process – from the patient to the payer and everyone in between. I asked him what advice he gives to his students and, not surprisingly, his answer was centered around inclusion. “Talk to the users, try to understand their needs. Talk to clinicians, talk to the insurance people, be open to others. Don’t be afraid that they will take away your ideas, just talk to people.”