Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

Abstract

In the last decade robotic devices have been applied in rehabilitation to overcome walking disability in neurologic diseases with promising results. Robot assisted gait training (RAGT) using the Lokomat seems not only to improve gait parameters but also the perception of well-being. Data on the psychosocial patient-robot impact are limited, in particular in the real-world of RAGT, in the rehabilitation setting. During rehabilitation training, the Lokomat can be considered an “assistive device for movement”. This allowed the use of the Psychosocial Impact of Assistive Device Scale- PIADS to describe patient interaction with the Lokomat. The primary aim of this pilot study was to evaluate the psychosocial impact of the Lokomat in an in-patient rehabilitation setting using the PIADS; secondary aims were to assess whether the psychosocial impact of RAGT is different between pathological sub-groups and if the Lokomat influenced functional variables (Functional Independence Measure scale–FIM and parameters provided by the Lokomat itself). Thirty-nine consecutive patients (69% males, 54.0±18.0 years) eligible for Lokomat training, with etiologically heterogeneous walking disabilities (Parkinson’s Disease, n = 10; Spinal Cord Injury, n = 21; Ictus Event, n = 8) were enrolled. Patients were assessed with the FIM before and after rehabilitation with Lokomat, and the PIADS was administered after the rehabilitative period with Lokomat. Overall the PIADS score was positive (35.8±21.6), as well as the three sub-scales, pertaining to “ability”, “adaptability” and “self-esteem” (17.2±10.4, 8.9±5.5 and 10.1±6.6 respectively) with no between-group differences. All patients significantly improved in gait measure and motor FIM scale (difference after—before treatment values: 11.7±9.8 and 11.2±10.3 respectively), increased treadmill speed (0.4 ± 0.2m/s), reduced body weight support (-14.0±9.5%) and guidance force (-13.1 ± 10.7%). This pilot study indicates that Lokomat, in a real-world in-patient setting, may have a generalised approval, independent of disease, underlining the importance of the psycho-social framework for patients training with assistive robotic-devices.

The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications

“…Standardized tests to evaluate the psychosocial impact in patients with SCI following robot-assisted training are lacking. Furthermore, the application of the Psychosocial Impact of the Assistive Device Scale (PIADS) on a sample of 10 patients demonstrated the benefits of training with Lokomat in patients with an impaired walking motor on the psychological aspect in addition to the motor benefits [ 51 ]. The absence of daily activity, and non-involvement in social life lead to depression, alcohol addiction and suicide [ 1 ].…”

Robotic Technology in Pediatric Neurorehabilitation. A Pilot Study of Human Factors in an Italian Pediatric Hospital

“…Three studies qualitatively assessed the expectations and experiences of pediatric patients affected by cerebral palsy and families regarding the use of Lokomat [41][42][43], and gathered positive results about the acceptability of the therapy. One study reported that the technology, as delivered in an in-patient setting, may have a positive psychosocial impact [40]. According to a study carried out in Colombia, most of the patients that use Lokomat as a rehabilitation therapy feel comfortable (47%), very safe (68%) and have a perspective of significant results with the therapy (68%).…”

“…Although in the literature studies, evaluating the ergonomic aspects of rehabilitation health technologies is progressively increasing [37], only a few are those are related to robotic devices for neurorehabilitation that also take into account both the physiotherapist and the patient [38,39]. Even rarer are in-depth analyses of these aspects in the pediatric field [40][41][42][43][44][45].…”

Movement therapy in advanced heart failure assisted by a lightweight wearable robot: a feasibility pilot study

“…As a result, longer duration of the exercise sessions and a higher training intensity can be achieved. [7][8][9][10][11] To date, this innovative approach has not been applied in cardiovascular rehabilitation training, despite its great potential to counteract the deconditioning experienced by patients with symptomatic chronic heart failure. The aim of this pilot study was to investigate the safety, feasibility, and tolerability of exoskeleton-type robotic-assisted mobilization protocols in patients with severe heart failure.…”

“…Robotic assistance can augment the effect of physical training by facilitating motor recovery, supporting balance and stability and thus improving exercise capacity to a greater degree than conventional, non‐assisted training. As a result, longer duration of the exercise sessions and a higher training intensity can be achieved 7–11 …”