Physiotherapists’ Experiences Using the Ekso Bionic Exoskeleton with Patients in a Neurological Rehabilitation Hospital: A Qualitative Study

Abstract

Use of bionic overground exoskeletons to assist with neurological rehabilitation is becoming increasingly prevalent and has important implications for physiotherapists and their patients. Yet, there is a paucity of research about the impact of integrating this technology on physiotherapists’ work. The purpose of this study was to explore how the training and implementation of using the Ekso robotic exoskeleton with patients affects physiotherapists’ work. An exploratory qualitative study of three physiotherapists working at a neurological rehabilitation centre in Eastern Canada was conducted using one-on-one semistructured interviews in July 2017. Audio recordings were transcribed verbatim, and data was coded and analyzed using thematic analysis. Six themes emerged from the data: developing organizational capacity; ethical use of technology; benefits of the equipment; challenges of the equipment; cognitive workload; and the technological environment. The results suggest that the adoption and integration of bionic exoskeletons into rehabilitation practice is not as simple as training physiotherapists and giving them the device. More research is needed to understand the increased cognitive demands of working with patients using technologically advanced exoskeletons within a dynamic, technology-rich healthcare environment, while managing patient expectations and ethical use.

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

“…This study explored the perspectives of persons with stroke and their physiotherapists using in-depth semi-structured interviews following a single-use experience with a H2 exoskeleton. To date only one study using qualitative research methods has specifically investigated physiotherapist perspectives of exoskeleton use in persons with stroke [ 14 ]. Currently, no literature using qualitative research methods exists on the perspectives of persons with stroke with respect to exoskeleton technology.…”

“…Although there is a large body of evidence supporting the inclusion of end-user perspectives both in retail marketing and design of medical devices to ensure that products and devices meet end-user needs [ 12 ], end-user perspectives with respect to assistive technology, such as the exoskeleton for post-stroke gait rehabilitation, appears to be lacking [ 14 , 36 ]. The literature suggests that it is important that end-users have an actual exoskeleton experience as perceptions of, and experience with exoskeleton technology are potentially quite different [ 20 ].…”

“…Wolff et al, (2014) utilized an online survey to evaluate perspectives on potential use of exoskeletons with wheelchair users, primarily persons with SCI, and healthcare professionals, but no PTs were included [25]. To date only one study by Read et al,(2020) specifically investigated perspectives of 3 PTs on exoskeleton use using semi-structured interviews with persons with SCI or stroke. Currently, a mixed-methods study is underway to investigate perspectives of PTs and persons with stroke [26].…”

“…Significant limitations persist in current exoskeleton designs such as weight, cost, size, speed and efficiency [ 11 ]. Although end-users’ perspectives are essential in the design and development of assistive technology [ 12 , 13 ], there is a paucity of literature from both persons with disabilities and physiotherapists (PTs) perspectives [ 14 , 15 ]. Over the last decade end-user perspectives have primarily been studied in spinal cord injury (SCI) in which four studies used semi-structured interviews [ 16 – 19 ], and 3 studies used survey methods [ 20 – 22 ] with sample size ranging from 3 to 20 persons.…”

Physiotherapy students’ perspectives on the use and implementation of exoskeletons as a rehabilitative technology in clinical settings

“…fitting, donning and doffing), excessive cost, and the need for multiple therapists' assistance were described as resource-specific barriers to adoption into clinical practice. The importance of considering resource demands was also emphasised by Read et al [36], who identified a need for organisational support to offset the increased resource investment required to integrate the exoskeleton into physiotherapists' practice. It is critical, as exoskeleton technology advances, that resource demands match availability in clinical settings.…”