The challenge

While adult patients have greatly benefited from robotic assistive technology (bionics) with reasonable success, younger patients were yet to reap these benefits.

The MOTION project aimed to take this modern technology and innovate this for a younger age group. With a focus on taking this technology from research to industry, it was intended that younger patients would have access to such life-changing equipment.

With the help of healthcare professionals, end users and policy makers across a transregional network (UK and Europe), engineering partners were supported to meet the project’s goal of providing bionics to children.

Understanding industry requirements

At the start of the project, the teams:

developed and established key collaborations around the fundamental aspects of patient use;
examined the appetite for technology in this field;
undertook significant, collaborative interaction with patients, carers, clinicians, physiotherapists, schools, and both NHS and non-NHS providers.

This type of technology had been used with adults, so there was already some awareness across various groups.

However, to develop, build and test the technology specifically for children was fraught with different challenges. The team needed to understand the requirements, potential and barriers to use the young end-users.

Thankfully, Canterbury Christ Church University is an established partner on Interreg funding bids, and staff were able to specifically interlink existing networks and increase contacts to support opportunities to discuss and collate data on ‘requirements’ associated with each stakeholder group. These outcomes informed significant decision-making for the engineers working on the project.

Analysing movement

Understanding the walking patterns of our younger patient group was essential and required the project teams to collaborate.

Walking (and other tasks) are more prominent in ‘typically developed’ (TD) children, and even more so in the data collected on children with cerebral palsy. Biomechanists working on the project developed walking ‘gait’ analysis software to detect gait issues and assessed the variability and adjustments required in TD and children with cerebral palsy.

Adjustments to walking pattern are critical to level ground walking and are of course far more complex in a real-world situation. Clinical partners in the project also wanted children to develop more control in the use of existing (e.g. ankle foot orthosis) and new technology.

This led the teams to design powered systems to consider ‘live’ movement and adjust accordingly.

Beyond the scope of this project, the research team were hopeful that if walking patterns were altered through the use of this technology, then less input from the motor driven components would still be required over time, to support independent patient progression.

This sounded quite simple, but the engineering challenge to deal with monitoring the variation in every step, then accommodate forces delivered by devices, was far from it.

The engineers had to create integrated walking gait detection with software solutions, which allowed for varied mechanical input (through the 3D printed individualised supports). Fundamentally, this end point was based on multiple inputs from collaborative partners to enable these innovations.

Therefore, through positive collaboration, the engineers were able to consider this to enable our young patients to access this equipment more readily.

The results

Based on industry requirements, one positive outcome is the training modules that were developed through an online portal, meaning that the community of stakeholders that contributed can now have resources to support others, including staff, parents and patients, alongside those training in multiple health-related fields.

As an exercise scientist working on this project, possibly the most useful component of this work was the honesty of responses from those who engaged. At all levels a community that challenges the concepts, the plans and staff is vital to project outcomes, and in this case if the devices do make it to market, then our critical friends from multiple stakeholder groups will have played a substantial part in the innovation, design and development process – and for that, we are incredibly grateful!

Looking toward the future, one of the outputs to be completed from this project is the publication of raw data. The walking gait data will be made open access to allow others to use and consider.

What’s more, without the various arms of support these data would not have been collected. The NHS’ ethical process is appropriately stringent, and key information and details across the project enabled this process to be completed before data collection.

Without input from engineers, NHS colleagues working with patient groups, exercise scientists and psychologists, these data would not have been collected, let alone be open access for other clinical and research groups to access without stakeholder engagement, highlighting the important part of every stakeholder group involved.

Training modules that CCCU developed will hopefully influence practice and remain at the forefront of learning in this field both across the UK and with European partners for a substantial period to come.

How we’ve benefitted

Thanks to this successful venture, we have greatly benefited from this positive, honest, reflective and well-informed collaborative project.

Some of these benefits include:

We have increased our contacts, professional relationships and profile across these communities for future developments.
We have appointed fixed term staff for this project, one of whom has moved into physiotherapy following the project completion.
We have amplified expertise at CCCU - in the School of Engineering, Technology and Design, we have awarded a Chair to an engineer from the project who is keen to maximise opportunities out of this venture, and the movement analysis technology provided by CCCU is at the forefront of his plans.
Our students that have supported the project have also added significant expertise and value to their profiles; meaningful experiences that have substantially helped the final phases of the project have been delivered by our students.

What we’ve learned

From this case study, we continue to reflect and take away key lessons that we will use to improve and prosper in future projects. Here are the lessons we’ve learned so far:

Knowledge is limited, but many have the desire to learn about the use of robotic assistive devices for patient care.
Evidence suggests that this technology is beneficial for young client groups.
Comprehensive training is a legacy of CCCU input from this project.
Multiple stakeholder input has enriched the design of devices with end user focus.
Devices (hip, ankle and full exoskeleton) have been piloted and are now in a cycle of refine pilot and retest in client groups.
The next phase will be training and reviewing longer term use of devices.

Overall, this collaboration with our multiple stakeholders has been a successful feat. While there’s still a long way to go in the field of robotics, here at Canterbury Christ Church University, we look forward to continuing our research and helping our wider community.