Real-Time Decision-Making on Whether to Incorporate Neurorehabilitation Technology: Informing Developers on a Day in the Life of a Therapist

Abstract

Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Here we focus on tracing the real-time behavior and rehabilitation technology (RT) use decisions of the primary gatekeepers of RT: rehabilitation therapists. Methods Three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR) to analyze the vignettes. Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to take into account the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

An analysis of usability evaluation practices and contexts of use in wearable robotics

“…We can therefore argue that one factor limiting the usability, acceptance, and translation of WRD for augmentation and assistance appears to be their goal of unsupervised, independent use. Moreover, the complexity of WRDs appears to be among a strong limiting factors of technology adoption, even for a supervised use in therapeutic applications [39]. Developing a robotic device with high functionality while keeping the design simple enough to be set up, used and maintained remains a central challenge in WRD.…”