Join us as we explore Medical Frontiers.

Spinal cord injuries reportedly affect around 20 million people worldwide.

While robot equipment, the latest technology, have improved the effectiveness of rehabilitation,

new challenges have emerged, including patient discontinuing their robot assisted therapies prematurely.

Today, we're going to delve into the efforts of a team seeking to develop reliable rehabilitation methods

that align with the patient's feelings and their needs.

In 2013, Otsuka Hiroyuki suffered a cervical spine injury while at work.

Spinal cord injuries can cause incomplete or complete paralysis.

In Otsuka's case, he experienced significant loss of function in his right leg and his right hand was paralyzed.

However, he retained mobility on his left side, and was diagnosed with incomplete paralysis.

I was hospitalized for nearly a year.

I recovered to the point where I could walk with
a brace and crutches, and was then discharged.

But because my right knee was locked in a brace,
I could only walk slowly and my balance was compromised.

This put a major strain on my lower back
and resulted in a painful hernia.

Otsuka felt the limitations of walking with a brace and crutches, and gradually shifted to a wheelchair.

He relied on it for nine years after his accident.

I suppressed my wish to walk again
because it made me sad.

Rehabilitation after a spinal cord injury is divided into three stages.

The first two weeks are called the acute stage.

Two weeks to six months after the injury is the recovery stage,

and anything beyond that is the chronic stage.

Traditionally, it was believed that rehabilitation becomes less effective when a patient reaches the chronic stage.

However, this belief is now being challenged by robotic rehabilitation.

In 2022, Otsuka learned of a facility specializing in such therapy and went for a consultation.

The facility was established by rehabilitation doctor Chin Takaaki,

who has been treating people with walking disabilities for over 30 years.

This footage shows Otsuka during his first visit to the facility.

Even while holding onto the parallel bars,

he could barely support his weight with his less-affected left leg.

Although he managed to move his right leg forward relying on his hip joint,

he could not plant it firmly on the floor.

His walking speed was extremely slow, a stark contrast from what is considered normal.

However, Chin was optimistic.

I was convinced he would be able to walk again.

So, Dr. Chin, thank you so much for your time today.

It's a great pleasure to have you on the program.

So in that case, why did you think that assisted rehab would be effective for him?

Given Otsuka's medical history, I don't think
anyone believed he could walk again.

But Otsuka was only incompletely,
not completely, paralyzed from his injury.

I had a gut feeling that using robots,
it might be achievable.

Otsuka spent four months in the hospital undergoing rehabilitation.

Because he was in the chronic phase, he began with training to help him regain the sensation of walking.

Years of relying on a wheelchair had caused both his body and his brain to forget how to walk.

The tool used for this purpose was a Japanese-made rehabilitation device called HAL.

When a person attempts to walk, the brain sends a signal via the nerves to the muscles to command the movement.

The signal appears very faintly on the skin surface.

The device detects it through sensors, which are attached to the paralyzed leg.

Based on this signal, the device assists with voluntary leg movements.

It establishes a connection between brain signals and leg movements.

Repeated use is meant to activate weakened neural pathways.

Put your weight on the tip of your toes
before putting your opposite leg out.

Otsuka underwent rehabilitation using this device twice a week.

This footage is from his first session.

Wow! You're walking!

You're doing great.

Otsuka was able to walk without using his arms to support his weight.

Rather than walking on my own, it felt
more like the device was helping me to walk.

This is Otsuka three weeks later.

His walking speed has increased significantly.

This shows Otsuka before he began rehabilitation with this device.

Initially, with his knee locked in a brace, he could only walk 34 meters in six minutes.

But after three months of using HAL, he was able to walk 132 meters in the same amount of time.

This is four times his earlier speed.

Chin believes the device helped Otsuka to regain the sensation of walking,

leading to a smoother swing of his right leg and a faster walking speed.

Rehabilitation using HAL was much
tougher than I had expected.

It left me with severe abdominal pain,
especially on my right side.

I'd always have to lie face down
for about an hour, enduring the pain.

Rehabilitation using the Japanese-made device HAL has been introduced in 19 countries and one region,

including the US and Germany, with reports of successful results.

German Professor Schildhauer has been using it since 2013 in the rehabilitation of around 340 patients,

including those in the acute phase.

At the beginning, we were just hoping that we can get patients up to walk when they wear the robots.

However, we saw not only that these patients became better in walking with the exoskeleton, but also without the exoskeleton.

And that we saw in all our chronic spinal cord injury patients.

So these patients were sitting in the wheelchair more than a year and up to 19 years.

Some patients were 19 years in a wheelchair and they started to walk again.

And that is a revolution.

It was just incredible to see the transition.

Many patients have said that using HAL has
helped them to remember how to walk again.

Some functions are difficult to regain
through conventional rehabilitation.

But we have high hopes that robots will enable
remarkable and unprecedented recoveries.

There are things that only robots can achieve.

However, there are challenges linked to this device.

Its use requires support from medical professionals with specialized knowledge,

making it difficult for patients to access the technology after leaving the hospital.

It is also costly and can only be used in indoor, barrier-free settings.

In Chin's research, all 18 individuals who underwent rehabilitation with the device showed improved walking function.

Two of them recovered enough to be able to walk independently in their daily lives.

The remaining 16 patients went back to using wheelchairs after leaving the hospital.

This is Otsuka after completing 3 months of rehabilitation with the device.

Even with crutches, his paralyzed right leg's knee shakes, making it impossible to support his weight.

To prevent this, he needs to keep his knee locked in a brace.

However, this brace results in an unnatural way of walking that strains his body.

My goal with walking isn't limited to improving
walking ability within medical settings.

I aim for patients to regain the ability to walk
at a level that allows them to resume

their daily lives in their communities.
That's my ultimate goal.

Chin began exploring ways to improve the walking function revived by the Japanese-made device to a level that was suitable for daily life.

After a long search, he learned of a German-made robotic device called the C-Brace.

It uses multiple sensors to detect real-time information such as the angle, direction, and speed of the knee.

This information is conveyed to the hydraulic cylinder.

When the right foot lands on the ground,

the cylinder applies resistance to the right knee joint to prevent it from giving way.

As the knee tilts forward and extends, indicating that the foot is leaving the ground,

the cylinder releases the resistance, allowing the knee to bend.

When the right foot swings forward, resistance is applied to the knee to prepare for landing.

This enables stable and smooth walking.

After three months of rehabilitation with the Japanese device,

Otsuka began a new training program using the German-made device.

This was the world's first trial of its kind.

During my first training session with the parallel
bars, I had a feeling that it might work.

The machine keeps my right knee from giving way.
I simply had to move my hip joint forward.

If I could move my right leg forward using
the hip joint, the C-Brace would do the rest.

After seven days of using the German device, Otsuka was able to walk with crutches.

And after 11 days of this therapy, he successfully strolled outside.

The Japanese device had helped him to recover the hip joint movements necessary for walking,

and with effective knee joint support from the German device, he became able to walk outdoors.

While using two different devices may sound like a simple idea,

it resulted in a significant improvement in Otsuka's walking ability.

Otsuka can now walk without crutches.

He can even navigate steps and uneven surfaces.

It's great that he can walk on a tilted road.

Otsuka regained his ability to walk, nine years after his accident.

His life changed dramatically after leaving the hospital.

He now leads a busy life as the chair of a local para-powerlifting association,

traveling around the country independently to compete.

I want to do what I couldn't do before.
I've received a lot of help from others,

so I want to give back, contribute
to society and live my life fully.

Are there any other patients that have had that success in?

Yes, 2 others have undergone this double-robot
rehabilitation, and recovered enough to

resume normal lives in their communities.
One has returned to work.

If these patients find jobs or rejoin society,

It will strongly motivate them and
positively impact those around them.

When using robots, our ultimate aim
should be to reach that level.

The staff at the rehabilitation center provides support to ensure patients can keep using robotic devices,

which are costly to purchase and maintain on their own.

They said I should use all available subsidies
to cover the high cost of making the device,

and that they would look into it before my stay.
No hospital has ever been so supportive.

They were providing such support to all of
the patients I met while in the hospital.

It's difficult to receive insurance support
without precedents.

I believe we have to gradually work
toward this goal, step by step.

I don't expect an immediate, society-wide
acceptance of robots that benefit everyone.

Instead, we need to work hard
to make it a reality.

Chin's team is also dedicating efforts to another field of rehabilitation:

robotic hand training for children born without hands or arms.

Robotic hands work like the Japanese robotic device HAL.

They detect myoelectric signals generated by the muscles

and translate them into the finger movements, allowing the user to grasp objects.

The high rate of prosthesis rejection among children has posed a significant challenge.

A survey in Canada found that 48.8 percent of children who began rehabilitation at age two or older rejected them.

For those who started before they turned two, 16.6 percent stopped using the device.

Our approach boasts a much lower
rejection rate than Western countries.

At our facility, the rejection rate among
children who began before the age of 2 is 0%.

- Zero?
- Yes, 0.

Wow, that's incredible.

Chin's team has trained 93 children in 22 years.

Among those who started at the age of two or later, 14.9 percent stopped using the device.

But among those who began before they turned two, the rejection rate has been zero.

10-year-old Fujimoto Haruto is fond of his robotic hand featuring his favorite baseball team's logo.

He was born without fingers on his left hand.

Once he entered kindergarten, he began to
realize that he was different from others.

He would cry and ask why he had no fingers,
and wonder whether anything could be done.

Haruto began training to use a pediatric myoelectric hand when he was five.

Grasp from above like this.
Good!

Are you ready?

Go!

Because there's no facility that provides this training nearby,

Haruto has made seven-hour round trips to the hospital for the past five years to attend regular appointments.

At the hospital, each child is assigned a dedicated therapist.

In some cases, the care continues into adulthood.

It's like raising a child. I look at his photos
and records and enjoy seeing his growth.

I was worried he might be too old to start
this training and potentially drop out.

Whether children will continue to use myoelectric hands depends heavily on when they start training.

If they start before turning 1, they can learn to
perceive the robotic hand as part of their bodies.

But if they start at age 2 or later,
they tend to see it as a tool.

In short, the later the training begins,

the more likely it is for children to see the hand as inconvenient and stop using it.

Chin's team provides thorough support so that children find their robotic hands comfortable and easy to use.

When you're sick, you can go to a local hospital.

But with prosthetics, there's no place to
inquire about them.

So you have to get in touch with a therapist.

Using social media, they set up a helpline for the children and their families.

This helpline offers detailed advice to address the minor worries the kids encounter at school or elsewhere.

He had to hammer nails during a class, but it was
difficult to hold them. He asked me what to do.

She asked the therapist for help.

He recommended using a tool rather than trying to hold them directly.

She came up with the idea to use clothespins to hold the nails.

The next day, he seemed really excited about
being able to hold the nails, so I was very happy.

It gives therapists great motivation when children feel a sense of achievement.

We learn from the children as they come up with
great solutions to overcome challenges.

The clothespin method was suggested by
a family, but it's now part of our arsenal of ideas.

We'd like to share it with all elementary
school kids with robotic hands.

Chin's team hopes to expand the support system to cater to the changing needs of the children as they grow.

It's essential to focus efforts on providing rehabilitation

that is specifically tailored to a patient's needs rather than relying solely on robot capabilities

and there are hopes that in the future there'll be more collaboration with researchers around the world

to promote patient-centered robotic rehabilitation.

Mindfulness, derived from Zen, is a good way to relieve mental and physical stress.

Today, we will learn easy ways to practice mindfulness from Kawano Taishu,

a psychiatrist who is also the head priest at a Zen temple with a history of over 600 years.

Traditionally, Zen and mindfulness hold the most
value when integrated into daily life.

This is a principle I hold dear.

Mindfulness meditation methods developed abroad
require you to meditate for long hours daily.

But I propose a more laid-back approach,
which I call "lazy meditation."

That is a great name.

Usually, zazen, or seated meditation, involves sitting cross-legged with eyes half closed for 30 to 40 minutes.

But Kawano says that even just one minute is beneficial.

First, sit on a small cushion with your back straight. You can also use a chair.

Just make sure you sit on the edge, with your legs slightly apart.

Face forward and focus your eyes on a spot on the floor two to three meters away.

The key is to focus on your breathing.

Don't try to control your breathing. Just feel your
breath as your body expands and contracts.

Even if stray thoughts come to mind, don't blame
yourself or think your meditation is failing.

Just redirect your focus on the rise
and fall of your body.

You know in English, sometimes we call that a "monkey mind," the mind is so incredibly busy.

We're thinking of all of these things that we have to do.

Having a "monkey mind" is common among humans,
thanks to our well-developed frontal lobe.

Instead of viewing it negatively, simply accept
that it is a natural part of being human.

This will free your mind from distractions
and boost your self-acceptance.

This in turn increases your self-compassion,
and makes you kinder to yourself.

I believe this is the goal of meditation.

Kawano believes that it's possible to eliminate distracting thoughts through household chores.

He especially recommends meditating while cleaning.

Wow! So you're doing it actually really quickly!

I would have imagined that you would have done it really slowly.

In Zen practice, it's crucial to be very quick yet
thorough so the mind has no room to wander.

In the world of Zen, cleaning is seen
as a way to cleanse the mind.

Cleaning up the immediate surroundings helps
to declutter thoughts of the past or the future.

That's one of the key teachings of Zen.

I'm definitely not going to be fast.

Start slowly, focusing only on the action and the sensation in your hands.

This will help you to gradually eliminate unwanted thoughts.

You can also practice lazy meditation while shining shoes.

Kawano says that engaging in simple, repetitive household chores like dishwashing can also reduce stress.

Incorporating meditation into household chores is
simply about doing what you normally do with care.

It's easy, promotes self-care and shows that
meditation can be a part of any daily activity.

Thank you so much.

Thank you.