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Chang CK, Lee C, Nuckols RW, Eckert-Erdheim A, Orzel D, Herman M, Traines J, Prokup S, Jayaraman A, Walsh CJ. Implementation of a unilateral hip flexion exosuit to aid paretic limb advancement during inpatient gait retraining for individuals post-stroke: a feasibility study. J Neuroeng Rehabil 2024; 21:121. [PMID: 39026268 PMCID: PMC11256417 DOI: 10.1186/s12984-024-01410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND During inpatient rehabilitation, physical therapists (PTs) often need to manually advance patients' limbs, adding physical burden to PTs and impacting gait retraining quality. Different electromechanical devices alleviate this burden by assisting a patient's limb advancement and supporting their body weight. However, they are less ideal for neuromuscular engagement when patients no longer need body weight support but continue to require assistance with limb advancement as they recover. The objective of this study was to determine the feasibility of using a hip flexion exosuit to aid paretic limb advancement during inpatient rehabilitation post-stroke. METHODS Fourteen individuals post-stroke received three to seven 1-hour walking sessions with the exosuit over one to two weeks in addition to standard care of inpatient rehabilitation. The exosuit assistance was either triggered by PTs or based on gait events detected by body-worn sensors. We evaluated clinical (distance, speed) and spatiotemporal (cadence, stride length, swing time symmetry) gait measures with and without exosuit assistance during 2-minute and 10-meter walk tests. Sessions were grouped by the assistance required from the PTs (limb advancement and balance support, balance support only, or none) without exosuit assistance. RESULTS PTs successfully operated the exosuit in 97% of sessions, of which 70% assistance timing was PT-triggered to accommodate atypical gait. Exosuit assistance eliminated the need for manual limb advancement from PTs. In sessions with participants requiring limb advancement and balance support, the average distance and cadence during 2-minute walk test increased with exosuit assistance by 2.2 ± 3.1 m and 3.4 ± 1.9 steps/min, respectively (p < 0.017). In sessions with participants requiring balance support only, the average speed during 10-meter walk test increased with exosuit by 0.07 ± 0.12 m/s (p = 0.042). Clinical and spatiotemporal measures of independent ambulators were similar with and without exosuit (p > 0.339). CONCLUSIONS We incorporated a unilateral hip flexion exosuit into inpatient stroke rehabilitation in individuals with varying levels of impairments. The exosuit assistance removed the burden of manual limb advancement from the PTs and resulted in improved gait measures in some conditions. Future work will understand how to optimize controller and assistance profiles for this population.
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Affiliation(s)
- Chih-Kang Chang
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Christina Lee
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Richard W Nuckols
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
- Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Asa Eckert-Erdheim
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dorothy Orzel
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Maxwell Herman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA.
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Herold L, Bosques G, Sulzer J. Clinical Uptake of Pediatric Exoskeletons: Pilot Study Using the Consolidated Framework for Implementation Research. Am J Phys Med Rehabil 2024; 103:302-309. [PMID: 38063305 DOI: 10.1097/phm.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
OBJECTIVE While the design and clinical evidence base of robot-assisted gait training devices has been advancing, few studies investigate user experiences with accessing and using such devices in pediatric rehabilitation. This pilot study aims to further the understanding of barriers encountered by clinicians and caregivers when implementing a robot-assisted gait training device. DESIGN A qualitative descriptive study was conducted at a local outpatient pediatric therapy center with a robot-assisted gait training exoskeleton. Six caregivers and six clinicians participated in semistructured interviews with brief surveys. The surveys were summarized with descriptive statistics. The interviews were analyzed using directed content analysis guided by the Consolidated Framework for Implementation Research. RESULTS The five most mentioned Consolidated Framework for Implementation Research constructs were knowledge and beliefs, relative advantage, child attributes, complexity, and access to knowledge and information. Caregivers experienced obstacles to accessing and trialing robot-assisted gait training devices. Clinicians expressed concerns regarding the feasibility of incorporating robot-assisted gait training into their clinic and preferred lower-tech gait training techniques. CONCLUSIONS While some aspects of access and usability may be addressed by device design and technological advancements, overcoming other barriers will require a deeper understanding of the roles of scientific evidence, personal beliefs, and current therapy workflows in the uptake of robotic interventions.
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Affiliation(s)
- Larissa Herold
- From the Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, Texas (LH); Department of Neurology, Dell Medical School, Austin, Texas (GB); Pediatric Rehabilitation Medicine, Dell Children's Medical Center, Austin, Texas (GB); and Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio (JS)
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Lin HP, Xu Y, Zhang X, Woolley D, Zhao L, Liang W, Huang M, Cheng HJ, Zhang L, Wenderoth N. A usability study on mobile EMG-guided wrist extension training in subacute stroke patients-MyoGuide. J Neuroeng Rehabil 2024; 21:39. [PMID: 38515192 PMCID: PMC10956308 DOI: 10.1186/s12984-024-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Effective stroke rehabilitation requires high-dose, repetitive-task training, especially during the early recovery phase. However, the usability of upper-limb rehabilitation technology in acute and subacute stroke survivors remains relatively unexplored. In this study, we introduce subacute stroke survivors to MyoGuide, a mobile training platform that employs surface electromyography (sEMG)-guided neurofeedback training that specifically targets wrist extension. Notably, the study emphasizes evaluating the platform's usability within clinical contexts. METHODS Seven subacute post-stroke patients (1 female, mean age 53.7 years, mean time post-stroke 58.9 days, mean duration per training session 48.9 min) and three therapists (one for eligibility screening, two for conducting training) participated in the study. Participants underwent ten days of supervised one-on-one wrist extension training with MyoGuide, which encompassed calibration, stability assessment, and dynamic tasks. All training records including the Level of Difficulty (LoD) and Stability Assessment Scores were recorded within the application. Usability was assessed through the System Usability Scale (SUS) and participants' willingness to continue home-based training was gauged through a self-developed survey post-training. Therapists also documented the daily performance of participants and the extent of support required. RESULTS The usability analysis yielded positive results, with a median SUS score of 82.5. Compared to the first session, participants significantly improved their performance at the final session as indicated by both the Stability Assessment Scores (p = 0.010, mean = 229.43, CI = [25.74-433.11]) and the LoD (p < 0.001; mean: 45.43, CI: [25.56-65.29]). The rate of progression differed based on the initial impairment levels of the patient. After training, participants expressed a keen interest in continuing home-based training. However, they also acknowledged challenges related to independently using the Myo armband and software. CONCLUSIONS This study introduces the MyoGuide training platform and demonstrates its usability in a clinical setting for stroke rehabilitation, with the assistance of a therapist. The findings support the potential of MyoGuide for wrist extension training in patients across a wide range of impairment levels. However, certain usability challenges, such as donning/doffing the armband and navigating the application, need to be addressed to enable independent MyoGuide training requiring only minimal supervision by a therapist.
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Affiliation(s)
- Hao-Ping Lin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Yang Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Xue Zhang
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Daniel Woolley
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland
| | - Lina Zhao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Weidi Liang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Mengdi Huang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, 16 Puhe Road, Shenyang, Liaoning, 110134, China
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE campus, 1 Create Way, CREATE Tower, #06-01, Singapore, 138602, Singapore.
- Department of Health Sciences and Technology, Neural Control of Movement Lab, ETH Zurich, Gloriastrasse 37/39 GLC G17.2, Zurich, 8092, Switzerland.
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Alt Murphy M, Pradhan S, Levin MF, Hancock NJ. Uptake of Technology for Neurorehabilitation in Clinical Practice: A Scoping Review. Phys Ther 2024; 104:pzad140. [PMID: 37856528 PMCID: PMC10851848 DOI: 10.1093/ptj/pzad140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake. METHODS This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers. RESULTS Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake. CONCLUSION Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development. IMPACT This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
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Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Yoshikawa K, Mutsuzaki H, Koseki K, Iwai K, Takeuchi R, Kohno Y. Gait training using a wearable robotic hip device for incomplete spinal cord injury: A preliminary study. J Spinal Cord Med 2023:1-13. [PMID: 37934493 DOI: 10.1080/10790268.2023.2273587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
CONTEXT/OBJECTIVE To explore changes in gait functions for patients with chronic spinal cord injury (SCI) before and after standard rehabilitation and rehabilitation with a wearable hip device, explore the utility of robot-assisted gait training (RAGT), and evaluate the safety and dose of RAGT. DESIGN Single-arm, open-label, observational study. SETTING A rehabilitation hospital. PARTICIPANTS Twelve patients with SCI. INTERVENTIONS Standard rehabilitation after admission in the first phase. RAGT for two weeks in the second phase. OUTCOME MEASURES Self-selected walking speed (SWS), step length, cadence, and the 6-minute walking distance were the primary outcomes. Walking Index for SCI score, lower extremity motor score, and spasticity were measured. Walking abilities were compared between the two periods using a generalized linear mixed model (GLMM). Correlations between assessments and changes in walking abilities during each period were analyzed. RESULTS After standard rehabilitation for 66.1 ± 36.9 days, a period of 17.6 ± 3.3 days of RAGT was safely performed. SWS increased during both periods. GLMM showed that the increase in cadence was influenced by standard rehabilitation, whereas the limited step length increase was influenced by RAGT. During RAGT, the increase in step length was related to an increase in hip flexor function. CONCLUSIONS Gait speed in patients with SCI increased after rehabilitation, including RAGT, in the short-term. This increase was associated with improved muscle function in hip flexion at the start of RAGT.Trial Registration: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR; UMIN000042025).
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
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Herrera-Valenzuela D, Díaz-Peña L, Redondo-Galán C, Arroyo MJ, Cascante-Gutiérrez L, Gil-Agudo Á, Moreno JC, Del-Ama AJ. A qualitative study to elicit user requirements for lower limb wearable exoskeletons for gait rehabilitation in spinal cord injury. J Neuroeng Rehabil 2023; 20:138. [PMID: 37848992 PMCID: PMC10583355 DOI: 10.1186/s12984-023-01264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE We aim to determine a comprehensive set of requirements, perceptions, and expectations that people with spinal cord injury (SCI) and the clinicians in charge of their rehabilitation have regarding the use of wearable robots (WR) for gait rehabilitation. BACKGROUND There are concerns due to the limited user acceptance of WR for gait rehabilitation. Developers need to emphasize understanding the needs and constraints of all stakeholders involved, including the real-life dynamics of rehabilitation centers. METHODS 15 people with SCI, 9 without experience with WR and 6 with experience with these technologies, and 10 clinicians from 3 rehabilitation centers in Spain were interviewed. A directed content analysis approach was used. RESULTS 78 codes grouped into 9 categories (physical results, usability, psychology-related codes, technical characteristics, activities, acquisition issues, context of use, development of the technologies and clinical rehabilitation context) were expressed by at least 20% of the users interviewed, of whom 16 were not found in the literature. The agreement percentage between each group and subgroup included in the study, calculated as the number of codes that more than 20% of both groups expressed, divided over the total amount of codes any of those two groups agreed on (≥ 20%), showed limited agreement between patients and clinicians (50.00%) and between both types of patients (55.77%). The limited accessibility and availability of lower limb exoskeletons for gait rehabilitation arose in most of the interviews. CONCLUSIONS The limited agreement percentage between patients and clinicians indicates that including both types of users in the design process of these technologies is important, given that their requirements are complementary. Engaging users with prior technology experience is recommended, as they often exhibit strong internal consensus and articulate well-defined requirements. This study adds up the knowledge available in the literature and the new codes found in our data, which enlighten important aspects that ought to be addressed in the field to develop technologies that respond to users' needs, are usable and feasible to implement in their intended contexts. APPLICATION The set of criteria summarized in our study will be useful to guide the design, development, and evaluation of WR for gait rehabilitation to meet user's needs and allow them to be implemented in their intended context of use.
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Affiliation(s)
- Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain.
| | - Laura Díaz-Peña
- Biomedical Engineering Department, Superior Technical School of Telecommunications Engineering, Rey Juan Carlos University, Fuenlabrada, Madrid, Spain
| | - Carolina Redondo-Galán
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, Toledo, Spain
| | - María José Arroyo
- Fundación del Lesionado Medular (Spinal Cord Injured Foundation), Madrid, Spain
| | | | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, Toledo, Spain
- Unit of Neurorehabilitation, Biomechanics and Sensorimotor Function (HNP-SESCAM), Associated Unit of R&D&I to the CSIC, Toledo, Spain
| | - Juan C Moreno
- Unit of Neurorehabilitation, Biomechanics and Sensorimotor Function (HNP-SESCAM), Associated Unit of R&D&I to the CSIC, Toledo, Spain
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, Madrid, Spain
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Putrino D, Krakauer JW. Neurotechnology’s Prospects for Bringing About Meaningful Reductions in Neurological Impairment. Neurorehabil Neural Repair 2022:15459683221137341. [DOI: 10.1177/15459683221137341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Here we report and comment on the magnitudes of post-stroke impairment reduction currently observed using new neurotechnologies. We argue that neurotechnology’s best use case is impairment reduction as this is neither the primary strength nor main goal of conventional rehabilitation, which is better at targeting the activity and participation levels of the ICF. The neurotechnologies discussed here can be divided into those that seek to be adjuncts for enhancing conventional rehabilitation, and those that seek to introduce a novel behavioral intervention altogether. Examples of the former include invasive and non-invasive brain stimulation. Examples of the latter include robotics and some forms of serious gaming. We argue that motor learning and training-related recovery are conceptually and mechanistically distinct. Based on our survey of recent results, we conclude that large reductions in impairment will need to begin with novel forms of high dose and high intensity behavioral intervention that are qualitatively different to conventional rehabilitation. Adjunct forms of neurotechnology, if they are going to be effective, will need to piggyback on these new behavioral interventions.
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Affiliation(s)
- David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John W. Krakauer
- Departments of Neurology, Neuroscience, and Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Stroke survivor perceptions of using an exoskeleton during acute gait rehabilitation. Sci Rep 2022; 12:14185. [PMID: 35986162 PMCID: PMC9391354 DOI: 10.1038/s41598-022-18188-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022] Open
Abstract
Robotic-assisted gait training (RAGT) devices allow intensive high repetition of the gait cycle in individuals with locomotor disability, with reduced therapist effort. In addition to usual rehabilitation, RAGT post-stroke improves the likelihood of regaining independent walking, with maximum efficacy identified in the acute and subacute phases of stroke. This study explores the usability and acceptance of RAGT among persons with stroke in an acute hospital setting and examines users’ perceptions of two different modes of robotic assistance provided during rehabilitation. A mixed-methods approach comprised semi-structed interviews of end-user perspectives of RAGT in an acute hospital setting following stroke and two 10-point Likert scales rating how comfortable and how natural robotic gait felt using different assistance modes. Content analysis of qualitative data was undertaken with results synthesised by common meaning units. Quantitative data were reported using summary statistics, with Spearmann’s correlation co-efficient examining the relationship between Likert scale ratings and measures of participants’ stroke related disability. Ten individuals (6 men; 4 women; mean age of 64.5. ± 13 years) were recruited in an acute hospital setting following admission with a stroke diagnosis. Content analysis of interview transcripts identified discussion units centring around positive aspects of how helpful the device was, negative aspects related to set-up time, weight of the device and multiple instructions delivered during use. Initially participants identified that the device could look intimidating, and they feared falling in the device but they subsequently identified the correct mindset for using the device is to trust the technology and not be afraid. Mean ratings for device comfort (7.94 ± 1.4) and how natural walking felt (7.05 ± 1.9) were favourable. Interestingly, a strong relationship was identified, whereby the higher the level of disability, the more natural participants rated walking in the device during maximal assistance mode (rho = 0.62; p = 0.138). This study suggests individuals in the early phases of stroke perceive RAGT to be acceptable and helpful in the main, with some associated negative aspects. Walking in the device was rated as comfortable and natural. Those with greater disability rated the assisted walking as more natural.
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Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Current physical therapy practice and implementation factors regarding the evidence-based 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline in Germany: a cross-sectional online survey. BMC Neurol 2022; 22:284. [PMID: 35907809 PMCID: PMC9338587 DOI: 10.1186/s12883-022-02780-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline recommendations and the associated implementation factors. METHODS A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%. RESULTS Data from 170 questionnaires were eligible for analysis. Participants' mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only 'intensive walking training without a treadmill' was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice. CONCLUSIONS Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage. TRIAL REGISTRATION The study was retrospectively registered to the German Clinical Trials Register ( DRKS00026681 ).
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Affiliation(s)
- Bettina Scheffler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany.
| | - Florian Schimböck
- Department of Nursing Sciences and Clinical Nursing, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Almut Schöler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
| | - Katrin Rösner
- Institute of Health Sciences, Department of Physiotherapy, University of Luebeck, Lübeck, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus-Senftenberg, Universitaetsplatz 1, 01968, Senftenberg, Germany
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