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Curtis S, Sheehan L, Buchman E, Bhattacharjya S. Clinicians' perspectives and usage of rehabilitation technology: a survey. Disabil Rehabil Assist Technol 2024; 19:2298-2305. [PMID: 37987735 DOI: 10.1080/17483107.2023.2284365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this study was to investigate clinicians' perspectives regarding their usage of rehabilitation technology in their day-to-day practice and uncover the factors that impact clinicians' use of rehabilitation technology in their daily practice. MATERIALS AND METHODS An online survey was used to gather cross-sectional data from American occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and speech language pathologists. This survey used Likert-scale, multiple choice, and free-response questions. RESULTS Approximately half (n = 56/105, 53.3%) of our clinicians reported using rehabilitation in their daily practice. Less than 20% (n = 18/105, 17.1%) of the respondents strongly agreed that they felt comfortable implementing new rehabilitation technology, and few reported that their workplace encouraged (n = 16/85, 18.8%) or strongly encouraged (n = 14/85, 16.5%) the use of rehabilitation technology in practice. Additionally, excluding the 2011-2020 graduate clinicians that reported that they had not learned about rehabilitation technology in school or fieldwork, few reported feeling prepared (n = 14/97, 14.4%) or very prepared (n = 4/97, 4.1%) to use rehabilitation technology after graduation. CONCLUSIONS Our findings have revealed a sizable knowledge-to-practice gap in regard to clinicians' preparedness to engage with and advocate for rehabilitation technology in their day-to-day practice.
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Affiliation(s)
- Sarah Curtis
- Department of Occupational Therapy, GA State University, Atlanta, GA, USA
| | | | - Emily Buchman
- Department of Occupational Therapy, GA State University, Atlanta, GA, USA
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Badawi AS, Mogharbel GH, Aljohani SA, Surrati AM. Predictive Factors and Interventional Modalities of Post-stroke Motor Recovery: An Overview. Cureus 2023; 15:e35971. [PMID: 37041905 PMCID: PMC10082951 DOI: 10.7759/cureus.35971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Stroke is the most common cause of motor impairment worldwide. Therefore, many factors are being investigated for their predictive and facilitatory effects on recovery of motor function after stroke. Motor recovery can be predicted through several factors, such as clinical assessment, clinical biomarkers, and gene-based variations. As for interventions, many methods are under experimental investigation that aim to improve motor recovery, including different types of pharmacological interventions, non-invasive stimulation, and rehabilitation training by inducing cortical reorganization, neuroplasticity, angiogenesis, changing the levels of neurotransmitters in the brain, and altering the inflammatory and apoptotic processes occurring after stroke. Studies have shown that clinical biomarkers combined with clinical assessment and gene-based variations are reliable factors for predicting motor recovery after stroke. Moreover, different types of interventions such as pharmacological agents (selective serotonin reuptake inhibitors {SSRI}, noradrenaline reuptake inhibitors {NARIs}, levodopa, and amphetamine), non-invasive stimulation, and rehabilitation training have shown significant results in improving functional and motor recovery.
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Sony M, Antony J, McDermott O. The impact of medical cyber–physical systems on healthcare service delivery. TQM JOURNAL 2022. [DOI: 10.1108/tqm-01-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of medical cyber–physical system (MCPS) in the healthcare is one of the means of transforming the landscape of the traditional healthcare service delivery system. The purpose of this study is to critically examine the impact of MCPS on the quality of healthcare service delivery.Design/methodology/approachThis paper uses an evidence-based approach, the authors have conducted a systematic literature review to study the impact of MCPS on healthcare service delivery. Fifty-four articles were thematically examined to study the impact of MCPS on eight characteristics of the healthcare service delivery proposed by the world health organisation.FindingsThe study proposes support that MCPS will positively impact (1) comprehensiveness, (2) accessibility, (3) coverage, (4) continuity, (5) quality, (6) person-centredness, (7) coordination, (8) accountability and (9) efficiency dimension of the healthcare service delivery. The study further draws nine propositions to support the impact of MCPS on the healthcare service delivery.Practical implicationsThis study can be used by stakeholders as a guide point while using MCPS in healthcare service delivery systems. Besides, healthcare managers can use this study to understand the performance of their healthcare system. This study can further be used for designing effective strategies for deploying MCPS to be effective and efficient in each of the dimensions of healthcare service delivery.Originality/valueThe previous studies have focussed on technology aspects of MCPS and none of them critically analysed the impact on healthcare service delivery. This is the first literature review carried out to understand the impact of MCPS on the nine dimensions of healthcare service delivery proposed by WHO. This study provides improved thematic awareness of the resulting body of knowledge, allowing the field of MCPS and healthcare service delivery to progress in a more informed and multidisciplinary manner.
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Cao N, Packel A, Marcy E, Sprik K, Harold E, Xiao R, Esquenazi A. Implementing Robotic-Assisted Gait Training in Acute Inpatient Stroke Rehabilitation: A Quality Improvement Initiative. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021; 4:168-173. [PMID: 38283707 PMCID: PMC10821733 DOI: 10.4103/jisprm-000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The recovery of independent walking is one of the major goals of stroke rehabilitation; however, due to the current acute inpatient rehabilitation care paradigm, the intensity of walking practice provided has been far below that recommended for motor recovery to occur. A quality improvement initiative was implemented to encourage the physical therapist (PT) to incorporate various robotic gait training devices as part of the standard allotted PT sessions to improve the intensity of gait training. Materials and Methods After 6 months, a retrospective review was performed to assess the feasibility of the robotic-assisted gait training (RAGT) intervention in limited-ambulatory stroke patients and determine preliminary efficacy of the RAGT program by analyzing Functional Index Measure (FIM) motor gain and accelerometer-based daily step counts in patients who received the RAGT versus a group treated with conventional therapy. Results About 30% of limited-ambulatory patients admitted to the stroke rehabilitation unit received consistent integrated RAGT without safety concerns. Compared to those who received conventional treatment, these patients showed greater mean FIM motor gain (32.30 versus 17.88) at discharge (P < 0.005) and higher number of step counts in PT sessions (P < 0.005). Age, gender, or admission FIM motor were not associated with FIM motor gain. Conclusions Across a 6-month initial implementation period, RAGT was feasible and was associated with higher repetition of walking practice and also with improved FIM motor scores in limited-ambulatory individuals in an acute inpatient stroke rehabilitation program. However, the frequency of RAGT and the percentage of patients participating need to further improve. Some strategies to address these concerns were identified.
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Affiliation(s)
- Ning Cao
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Andrew Packel
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Elizabeth Marcy
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Kelly Sprik
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Erika Harold
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
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Xu Y, Tong M, Ming WK, Lin Y, Mai W, Huang W, Chen Z. A Depth Camera-Based, Task-Specific Virtual Reality Rehabilitation Game for Patients With Stroke: Pilot Usability Study. JMIR Serious Games 2021; 9:e20916. [PMID: 33759795 PMCID: PMC8078039 DOI: 10.2196/20916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/01/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background The use of virtual reality is popular in clinical rehabilitation, but the effects of using commercial virtual reality games in patients with stroke have been mixed. Objective We developed a depth camera–based, task-specific virtual reality game, Stomp Joy, for poststroke rehabilitation of the lower extremities. This study aims to assess its feasibility and clinical efficacy. Methods We carried out a feasibility test for Stomp Joy within representative user groups. Then, a clinical efficacy experiment was performed with a randomized controlled trial, in which 22 patients with stroke received 10 sessions (2 weeks) of conventional physical therapy only (control group) or conventional physical therapy plus 30 minutes of the Stomp Joy intervention (experimental group) in the clinic. The Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index (MBI), Berg Balance Scale (BBS) score, single-leg stance (SLS) time, dropout rate, and adverse effects were recorded. Results This feasibility test showed that Stomp Joy improved interest, pressure, perceived competence, value, and effort using the Intrinsic Motivation Inventory. The clinical efficacy trial showed a significant time-group interaction effect for the FMA-LE (P=.006), MBI (P=.001), BBS (P=.004), and SLS time (P=.001). A significant time effect was found for the FMA-LE (P=.001), MBI (P<.001), BBS (P<.001), and SLS time (P=.03). These indicated an improvement in lower extremity motor ability, basic activities of daily living, balance ability, and single-leg stance time in both groups after 2 weeks of the intervention. However, no significant group effects were found for the FMA-LE (P=.06), MBI (P=.76), and BBS (P=.38), while a significant group interaction was detected for SLS time (P<.001). These results indicated that the experimental group significantly improved more in SLS time than did the control group. During the study, 2 dropouts, including 1 participant who fell, were reported. Conclusions Stomp Joy is an effective depth camera–based virtual reality game for replacing part of conventional physiotherapy, achieving equally effective improvement in lower extremity function among stroke survivors. High-powered randomized controlled studies are now needed before recommending the routine use of Stomp Joy in order to confirm these findings by recruiting a large sample size.
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Affiliation(s)
- Yangfan Xu
- The First Affiliated Hospital of Jinan University, Guangzhou, China.,The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meiqinzi Tong
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-Kit Ming
- School of Medicine, Jinan University, Guangzhou, China
| | - Yangyang Lin
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wangxiang Mai
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Weixin Huang
- Guangzhou Sanhao Computer Technology Co Ltd, Guangzhou, China
| | - Zhuoming Chen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
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Fang J, Schuwey A, Stocker N, Pedrini B, Sampaio A, Hunt KJ. Preliminary development and technical evaluation of a belt-actuated robotic rehabilitation platform. Technol Health Care 2020; 29:595-607. [PMID: 32741796 PMCID: PMC8203225 DOI: 10.3233/thc-202392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: To provide effective rehabilitation in the early post-injury stage, a novel robotic rehabilitation platform is proposed, which provides full-body arm-leg rehabilitation via belt actuation to severely disabled patients who are restricted to bed rest. OBJECTIVE: To design and technically evaluate the preliminary development of the rehabilitation platform, with focus on the generation of various leg movements. METHODS: Two computer models were developed by importing the components from SolidWorks into Simscape Multibody in MATLAB. This allowed simulation of various stepping movements in supine-lying and side-lying positions. Two belt-actuated test rigs were manufactured and automatic control programs were developed in TIA Portal. Finally, the functionality of the test rigs was technically evaluated. RESULTS: Computer simulation yielded target positions for the generation of various stepping movements in the experimental platforms. The control system enabled the two-drive test rig to provide three modes of stepping in a supine position. In addition, the four-drive test rig produced walking-like stepping in a side-lying position. CONCLUSIONS: This work confirmed the feasibility of the mechanical development and control system of the test rigs, which are deemed applicable for further development of the overall novel robotic rehabilitation platform.
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Affiliation(s)
- Juan Fang
- Institute for Rehabilitation and Performance Technology IRPT, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Andres Schuwey
- Institute for Rehabilitation and Performance Technology IRPT, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Niklaus Stocker
- Liberty MedTech Sagl, C/O OpenLab Group SA, Ticino, Switzerland
| | - Brian Pedrini
- Liberty MedTech Sagl, C/O OpenLab Group SA, Ticino, Switzerland
| | - Antonio Sampaio
- Liberty MedTech Sagl, C/O OpenLab Group SA, Ticino, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology IRPT, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
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Picelli A, Munari D, Modenese A, Filippetti M, Saggioro G, Gandolfi M, Corain M, Smania N. Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study. Eur J Phys Rehabil Med 2020; 56:444-450. [PMID: 32096616 DOI: 10.23736/s1973-9087.20.06112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. AIM To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. DESIGN Proof-of-concept, pilot, randomized controlled trial. SETTING University hospital. POPULATION Twenty adult outpatients with distal radius fracture due to wrist injury. METHODS All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. RESULTS No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. CONCLUSIONS Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. CLINICAL REHABILITATION IMPACT The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - .,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy -
| | - Daniele Munari
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Angela Modenese
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriele Saggioro
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Massimo Corain
- Unit of Hand Surgery, Department of Surgery and Odontology, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
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8
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Koseki K, Yozu A, Takano H, Abe A, Yoshikawa K, Maezawa T, Kohno Y, Mutsuzaki H. Gait training using the Honda Walking Assist Device® for individuals with transfemoral amputation: A report of two cases. J Back Musculoskelet Rehabil 2020; 33:339-344. [PMID: 31929139 PMCID: PMC7175943 DOI: 10.3233/bmr-191726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. OBJECTIVE This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. METHODS This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. RESULTS SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. CONCLUSIONS Gait training using the HWA was safe and effective for improving the gait of two TF amputees.
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Affiliation(s)
- Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Rehabilitation, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hanako Takano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Atsushi Abe
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Takayuki Maezawa
- Department of Physical Therapy, 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
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
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9
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Clark WE, Sivan M, O'Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. J Rehabil Assist Technol Eng 2019; 6:2055668319863557. [PMID: 31763052 PMCID: PMC6854750 DOI: 10.1177/2055668319863557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
This review evaluates the effectiveness of robotic and virtual reality technologies used for neurological rehabilitation in stroke survivors. It examines each rehabilitation technology in turn before considering combinations of these technologies and the complexities of rehabilitation outcome assessment. There is high-quality evidence that upper-limb robotic rehabilitation technologies improve movement, strength and activities of daily living, whilst the evidence for robotic lower-limb rehabilitation is currently not as convincing. Virtual reality technologies also improve activities of daily living. Whilst the benefit of these technologies over dose-controlled conventional rehabilitation is likely to be small, there is a role for both technologies as part of a broader rehabilitation programme, where they may help to increase the intensity and amount of therapy delivered. Combining robotic and virtual reality technologies in a rehabilitation programme may further improve rehabilitation outcomes and we would advocate randomised controlled trials of these technologies in combination.
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Affiliation(s)
- William E Clark
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,National Institute of Health Research Devices for Dignity MedTech Co-operative, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
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10
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Nwosu AC, Sturgeon B, McGlinchey T, Goodwin CD, Behera A, Mason S, Stanley S, Payne TR. Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats. Palliat Med 2019; 33:1106-1113. [PMID: 31250734 PMCID: PMC6691596 DOI: 10.1177/0269216319857628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Medical robots are increasingly used for a variety of applications in healthcare. Robots have mainly been used to support surgical procedures, and for a variety of assistive uses in dementia and elderly care. To date, there has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care. AIM The objective of this article is to examine the possible future impact of medical robotics on palliative, supportive care and end-of-life care. Specifically, we will discuss the strengths, weaknesses, opportunities and threats (SWOT) of this technology. METHODS A SWOT analysis to understand the strengths, weaknesses, opportunities and threats of robotic technology in palliative and supportive care. RESULTS The opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. However, there are a number of technical, societal, economic and ethical factors which need to be considered to ensure meaningful use of this technology in palliative care. CONCLUSION Robotics could have a number of potential applications in palliative, supportive and end-of-life care. Future work should evaluate the health-related, economic, societal and ethical implications of using this technology. There is a need for collaborative research to establish use-cases and inform policy, to ensure the appropriate use (or non-use) of robots for people with serious illness.
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Affiliation(s)
- Amara Callistus Nwosu
- 1 Academic Palliative & End of Life Care Department, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK.,2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK.,3 Marie Curie Hospice Liverpool, Liverpool, UK
| | - Bethany Sturgeon
- 4 Bristol Robotics Laboratory, University of Bristol, Bristol, UK
| | - Tamsin McGlinchey
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK
| | - Christian Dg Goodwin
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK.,5 US-UK Fulbright Commission, London, UK
| | - Ardhendu Behera
- 6 Department of Computer Science, Edge Hill University, Ormskirk, UK
| | - Stephen Mason
- 2 Palliative Care Institute Liverpool (PCIL), University of Liverpool, Liverpool, UK
| | | | - Terry R Payne
- 7 Department of Computer Science, University of Liverpool, Liverpool, UK
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11
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Milia P, Peccini M, De Salvo F, Sfaldaroli A, Grelli C, Lucchesi G, Sadauskas N, Rossi C, Caserio M, Bigazzi M. Rehabilitation with robotic glove (Gloreha) in poststroke patients. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/digm.digm_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Lo K, Stephenson M, Lockwood C. The economic cost of robotic rehabilitation for adult stroke patients: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:1593-1598. [PMID: 30113542 DOI: 10.11124/jbisrir-2017-003635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the best available evidence on the economic cost of robotic rehabilitation for adult stroke patients to improve their motor movement abilities. More specifically, the objective is to identify the evidence on the economic cost of robotic training compared to conventional physiotherapy for adult stroke patients, from the perspective of hospitals.
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Affiliation(s)
- Kenneth Lo
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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13
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Cerasa A, Pignolo L, Gramigna V, Serra S, Olivadese G, Rocca F, Perrotta P, Dolce G, Quattrone A, Tonin P. Exoskeleton-Robot Assisted Therapy in Stroke Patients: A Lesion Mapping Study. Front Neuroinform 2018; 12:44. [PMID: 30065642 PMCID: PMC6056631 DOI: 10.3389/fninf.2018.00044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Technology-supported rehabilitation is emerging as a solution to support therapists in providing a high-intensity, repetitive and task-specific treatment, aimed at improving stroke recovery. End-effector robotic devices are known to positively affect the recovery of arm functions, however there is a lack of evidence regarding exoskeletons. This paper evaluates the impact of cerebral lesion load on the response to a validated robotic-assisted rehabilitation protocol. Methods: Fourteen hemiparetic patients were assessed in a within-subject design (age 66.9 ± 11.3 years; 10 men and 4 women). Patients, in post-acute phase, underwent 7 weeks of bilateral arm training assisted by an exoskeleton robot combined with a conventional treatment (consisting of simple physical activity together with occupational therapy). Clinical and neuroimaging evaluations were performed immediately before and after rehabilitation treatments. Fugl-Meyer (FM) and Motricity Index (MI) were selected to measure primary outcomes, i.e., motor function and strength. Functional independance measure (FIM) and Barthel Index were selected to measure secondary outcomes, i.e., daily living activities. Voxel-based lesion symptom mapping (VLSM) was used to determine the degree of cerebral lesions associated with motor recovery. Results: Robot-assisted rehabilitation was effective in improving upper limb motor function recovery, considering both primary and secondary outcomes. VLSM detected that lesion load in the superior region of the corona radiata, internal capsule and putamen were significantly associated with recovery of the upper limb as defined by the FM scores (p-level < 0.01). Conclusions: The probability of functional recovery from stroke by means of exoskeleton robotic rehabilitation relies on the integrity of specific subcortical regions involved in the primary motor pathway. This is consistent with previous evidence obtained with conventional neurorehabilitation approaches.
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Affiliation(s)
- Antonio Cerasa
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy.,Neuroimaging Unit, IBFM-CNR, Catanzaro, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | | | - Sebastiano Serra
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | | | | | | | - Giuliano Dolce
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
| | - Aldo Quattrone
- Neuroimaging Unit, IBFM-CNR, Catanzaro, Italy.,Neuroscience Research Centre, University Magna Græcia, Catanzaro, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN) Crotone, Crotone, Italy
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Lo K, Stephenson M, Lockwood C. Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:3049-3091. [PMID: 29219877 DOI: 10.11124/jbisrir-2017-003456] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability, and rehabilitation, involving repetitive, high intensity, task-specific exercises, is the pathway to restoring motor skills. Robotic assistive devices are increasingly being used and it is hoped that with robotic devices, rehabilitation progress can be achieved for patients. OBJECTIVES To examine the effectiveness of robotic devices in the rehabilitation of stroke patients for upper limb mobility, lower limb mobility, and activities of daily living. The sustainability of treatment effect was also examined. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult stroke patients 18 years and over. TYPES OF INTERVENTION(S) Rehabilitation of stroke patients using robotic devices with assistive automation, compared to conventional physiotherapy. OUTCOMES Motor movements of upper limbs, walking movement of lower limbs and activities of daily living, including follow-up measurements to examine the sustainability of treatment effect. TYPES OF STUDIES Randomized and controlled clinical trials. SEARCH STRATEGY Published and unpublished studies in English were searched. METHODOLOGICAL QUALITY All studies meeting the review inclusion criteria were independently assessed for methodological quality by two reviewers. DATA EXTRACTION Quantitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS Quantitative data were pooled in statistical meta-analysis. Effect sizes expressed as standardized mean difference, 95% confidence intervals and levels of heterogeneity (I) were calculated. Where statistical pooling was not possible, the findings were presented in narrative form. RESULTS Fifty-one studies with 1798 patients were included in this review. Thirty studies examined upper limb interventions and 21 studies evaluated lower limb gait training. Non-significant results were found for upper limb (SMD 0.07, 95% CI -0.11 to 0.26, I = 41%, P = 0.45), lower limb (SMD 0.17, 95% CI -0.15 to 0.48, I = 75%, P = 0.31) and activities of daily living (SMD 0.11, 95% CI -0.11 to 0.33, I = 66%, P = 0.32). For patients with severely impaired lower limbs, a significant difference was observed in favor of robotics (SMD 0.41, 95% CI 0.19 to 0.63, I = 28%, P = 0.0003). P-value analysis did not show significant results for the sustainability of treatment effect post intervention. CONCLUSIONS Robotic training is just as effective as conventional training for upper limb motor movement, lower limb walking mobility and for activities of daily living. For lower limb patients with severe impairment, robotic training produces better outcomes than conventional training. The sufficient quantity of studies included and the reasonable quality of Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence support the findings.For treatment sustainability of upper and lower limbs, robotic training is just as effective as conventional training. However, the low quality of GRADE evidence and the lower number of studies included require caution for this finding. For treatment sustainability of activities of daily living, the better quality of GRADE evidence and the larger number of studies analyzed indicate that robotic training is just as effective as conventional training.
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Affiliation(s)
- Kenneth Lo
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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