Rehabilitation assisted by robotic and electromechanical devices for people with neurological disabilities: contributions for the preparation of a national conference in Italy

The Regulation of Artificial Intelligence in Digital Radiology in the Scientific Literature: A Narrative Review of Reviews

Today, there is growing interest in artificial intelligence (AI) in the field of digital radiology (DR). This is also due to the push that has been applied in this sector due to the pandemic. Many studies are devoted to the challenges of integration in the health domain. One of the most important challenges is that of regulations. This study conducted a narrative review of reviews on the international approach to the regulation of AI in DR. The design of the study was based on: (I) An overview on Scopus and Pubmed (II) A qualification and eligibility process based on a standardized checklist and a scoring system. The results have highlighted an international approach to the regulation of these systems classified as "software as medical devices (SaMD)" arranged into: ethical issues, international regulatory framework, and bottlenecks of the legal issues. Several recommendations emerge from the analysis. They are all based on fundamental pillars: (a) The need to overcome a differentiated approach between countries. (b) The need for greater transparency and publicity of information both for SaMDs as a whole and for the algorithms and test patterns. (c) The need for an interdisciplinary approach that avoids bias (including demographic) in algorithms and test data. (d) The need to reduce some limits/gaps of the scientific literature production that do not cover the international approach.

Ethics and Automated Systems in the Health Domain: Design and Submission of a Survey on Rehabilitation and Assistance Robotics to Collect Insiders’ Opinions and Perception

Background: The problem of the relationship between ethics and robotics is very broad, has important implications, and has two large areas of impact: the first is conduct in research, development, and use in general. The second is the implication of the programming of machine ethics. Purpose: Develop and administer a survey of professionals in the health domain collection of their positions on ethics in rehabilitation and assistance robotics. Methods: An electronic survey was designed using Microsoft Forms and submitted to 155 professionals in the health domain (age between 23 and 64 years; 78 males, mean age 43.7, minimum age 24, maximum age 64; 77 females, mean age 44.3, minimum age 23, maximum age 64) using social media. Results and discussion: The outcome returned: (a) the position on ethics training during university studies and in the world of work, (b) the organizational aspects hindered by ethics and those to be perfected in relation to ethics, (c) issues of ethical concern, (d) structured feedback on the usefulness of the methodology along with considerations of open text. Conclusions: An electronic survey methodology has allowed the structured collection of information on positions towards ethics in this sector. Encouraging feedback from the participants suggests the continuation of the study is beneficial. A continuation is expected, expanding the audience of professionals involved and perfecting the survey with the support of scientific companies.

The Artificial Intelligence in Digital Radiology: Part 1: The Challenges, Acceptance and Consensus

Artificial intelligence is having important developments in the world of digital radiology also thanks to the boost given to the research sector by the COVID-19 pandemic. In the last two years, there was an important development of studies focused on both challenges and acceptance and consensus in the field of Artificial Intelligence. The challenges and acceptance and consensus are two strategic aspects in the development and integration of technologies in the health domain. The study conducted two narrative reviews by means of two parallel points of view to take stock both on the ongoing challenges and on initiatives conducted to face the acceptance and consensus in this area. The methodology of the review was based on: (I) search of PubMed and Scopus and (II) an eligibility assessment, using parameters with 5 levels of score. The results have: (a) highlighted and categorized the important challenges in place. (b) Illustrated the different types of studies conducted through original questionnaires. The study suggests for future research based on questionnaires a better calibration and inclusion of the challenges in place together with validation and administration paths at an international level.

Information Security in Medical Robotics: A Survey on the Level of Training, Awareness and Use of the Physiotherapist

Cybersecurity is becoming an increasingly important aspect to investigate for the adoption and use of care robots, in term of both patients' safety, and the availability, integrity and privacy of their data. This study focuses on opinions about cybersecurity relevance and related skills for physiotherapists involved in rehabilitation and assistance thanks to the aid of robotics. The goal was to investigate the awareness among insiders about some facets of cybersecurity concerning human-robot interactions. We designed an electronic questionnaire and submitted it to a relevant sample of physiotherapists. The questionnaire allowed us to collect data related to: (i) use of robots and its relationship with cybersecurity in the context of physiotherapy; (ii) training in cybersecurity and robotics for the insiders; (iii) insiders' self-assessment on cybersecurity and robotics in some usage scenarios, and (iv) their experiences of cyber-attacks in this area and proposals for improvement. Besides contributing some specific statistics, the study highlights the importance of both acculturation processes in this field and monitoring initiatives based on surveys. The study exposes direct suggestions for continuation of these types of investigations in the context of scientific societies operating in the rehabilitation and assistance robotics. The study also shows the need to stimulate similar initiatives in other sectors of medical robotics (robotic surgery, care and socially assistive robots, rehabilitation systems, training for health and care workers) involving insiders.

Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE)

BACKGROUND

Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic.

OBJECTIVE

To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models.

METHODS

A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded.

RESULTS

Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table.

CONCLUSION

The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity.

The Cybersecurity and the Care Robots: A Viewpoint on the Open Problems and the Perspectives

Care robots represent an opportunity for the health domain. The use of these robots has important implications. They can be used in surgery, rehabilitation, assistance, therapy, and other medical fields. Therefore, care robots (CR)s, have both important physical and psychological implications during their use. Furthermore, these devices, meet important data in clinical applications. These data must be protected. Therefore, cybersecurity (CS) has become a crucial characteristic that concerns all the involved actors. The study investigated the collocation of CRs in the context of CS studies in the health domain. Problems and peculiarities of these devices, with reference to the CS, were faced, investigating in different scientific databases. Highlights, ranging also from ethics implications up to the regulatory legal framework (ensuring safety and cybersecurity) have been reported. Models and cyber-attacks applicable on the CRs have been identified.

Opportunities and Problems of the Consensus Conferences in the Care Robotics

Care robots represent an opportunity for the health domain. The use of these devices has important implications. They can be used in surgical operating rooms in important and delicate clinical interventions, in motion, in training-and-simulation, and cognitive and rehabilitation processes. They are involved in continuous processes of evolution in technology and clinical practice. Therefore, the introduction into routine clinical practice is difficult because this needs the stability and the standardization of processes. The agreement tools, in this case, are of primary importance for the clinical acceptance and introduction. The opinion focuses on the Consensus Conference tool and: (a) highlights its potential in the field; (b) explores the state of use; (c) detects the peculiarities and problems (d) expresses ideas on how improve its diffusion.