By Giulia Bovassi

Addressing the issue of robotics is now a need that cannot be postponed, particularly in recent times, since a rapid acceleration forced this close face-to-face between robotics and human reality. The technical examination offered by the experts conceptually prepares for the personal testimony of Carmine Consalvi.

This third afternoon, dedicated to the interaction between different forms of specialized knowledge, brought the theory into praxis, not only through the interventions of Giovanni Morone and his colleague, Marco Iosa, but also through the autobiographical note of the young Carmine Consalvi, 31 years, whose history is linked to the exoskeleton application in rehabilitation. As a patient, Carmine brought an important fact back to the heart of the research so far conducted, easily to get lost when you enter conceptually into the bioethical issues, namely the human being. Claudio Bonito, member of the GdN and coordinator of the research subgroup on “Posthumanism”, introducing this last intervention as the conclusion of the afternoon session, contrasted the “to do” with the “to act”: the action framework is working on new moving realities. That Vitruvian man, from whom humanism took inspiration for years, is challenged by the external act, a product of man, the artifice of the creative mind, which runs the risk of reductively exhausting himself in himself, concealing the ultimate destination of a “to do” that makes itself “to act.” Empathy takes over. Carmine shared the following: the invention rushed in my aid by physically, psychologically and humanly giving me new forces, driven by the determination arose in succeeding ex novo to relate myself with someone looking into his eyes, which, backward, the view of the wheelchair, from the bottom towards the other, failed. Six years ago, the road accident: a trauma that drastically influenced his life and his habits causing him the lack of voluntary residual movements, removing the complete control of the trunk; aspects to which Carmine felt called in a physical and existential rehabilitative response. After learning about the exoskeleton, he decided to try it, firstly to test whether innovation was ready for him. The patient’s feedback lies on the adaptability of the robot to its psychological, as well as physical, predisposition. The device is applied when you let it; in this sense, Carmine spoke of a subjective, non-standardized reaction to this type of technology, where a non-marginal role in his case was played by constancy and willpower.

A closure which is in line with the opening of the seminar conducted by Morone, “The right robot for the right person at the right time: state of the art, future perspectives on the use of robots in neuro-rehabilitation,” which accompanied the reflection through the work done at the IRCCS Santa Lucia, where they deal with new technologies used in neuro-rehabilitation. Complex applications under multiple points of view, from the costs to the much longer rehabilitation times, up to the same effectiveness; factors assumed by a part of experts and researchers with extreme skepticism and, by the other part, with excessive optimism, two ways which made the relationship between therapy and technology not always linear – as explained by the professor. Then the fundamental question reiterated by. Morone, pervasive in all the neuro-rehabilitative practice, is: “in the moment when we have to push the neuro-plastic capacity to its maximum for recovery, functionality and ability, during the hospitalization (especially in patients suffering from stroke), did it provide a sufficient stimulus for the patients to their recover?” Here then returns the example embodied by Carmine himself, although with different clinical situations: to know which patients can benefit from therapeutic robotics, so from a generic question “is this robot generally effective?” to “for whom this robot is effective?” We need to change the question because the focus has changed. Within their research group, a team of specialists during about ten years of observation, noted how the resistance was massively sedimented in people psychologically proven by states of anxiety or stress, emotionally disturbed by the robotic element. By looking for a propulsive force in brain plasticity we learn first that there cannot be “any patient” for “any robot,” so that the neuro-rehabilitation principles can be facilitated or increased thanks to the robotic supplement.

Marco Iosa spoke on “The ethics of rehabilitation robots. The three laws of neuro-robotics”, with clear reference to I. Asimov, as the Three Laws of Robotics and to its explanatory filmography, such as “I, Robot.” Robots are designed for three types of work: the dirty one, the boring one and the dangerous one. In the case of rehabilitation or, generically, in medicine, there is a need for adaptability with what the patient wants to do or feels he can do, following a procedure that is very different from what is normally followed by pharmacovigilance. Thus, we could outline three modern laws of robotics in the health field: 

1) a robot for neuro-rehabilitation may not injure a patient or allow a patient to come to harm;

2) a robot must obey the orders given it by the therapists, provided that such orders do not contravene the First Law;

3) a robot must adapt its functioning to the patient’s abilities in a transparent way as long as this does not conflict with the First or Second Laws.

This structure is affected by the difficulty of the “Paradox of efficacy”, i.e. how to benefit from a proven effectiveness-risk criterion. The resolution is obtained changing the request, that is asking for whom it is effective (as already said, the anxious subject, if called to choose between robot and physiotherapist, opts for the latter). The professor noted, “the robot is like the invention of the machine; it answers the question: “what can you not do for the patient?” We thus tread on the limit not only between effectiveness and risk, but between therapeutic and enhancement, highlighted by the performance accomplished with cerebral, electrical or magnetic stimulation. What purpose and what distinction is made between what is therapeutically beneficial and what an enhancement? What is the distinction between treatments to provide for learning or athletic difficulties, emotional or traumatic management in the military field, etc.? Countless examples for a single ethical macro-question: is all that is technically possible also morally licit?