Therapists’ experience of training and implementing an exoskeleton in a rehabilitation centre

Mortenson, W. Ben; Pysklywec, Alex; Chau, Leena W.; Prescott, Mike; Townson, Andrea

doi:10.1080/09638288.2020.1789765

Cited by 26 publications

(45 citation statements)

References 27 publications

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“…This study was conducted with a nested qualitative component of patient and therapist acceptance of exoskeleton-based physical therapy; patients viewed exoskeleton-based physical therapy highly favorably and felt a sense of greater opportunity and effectiveness with exoskeleton training [ 64 ]. These findings are supported by other qualitative studies exploring therapists’ perceptions towards the utility of an exoskeleton in general practice [ 65 , 66 ].…”

Section: Discussionsupporting

confidence: 84%

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

Louie

Durocher

Schneeberg

et al. 2021

J NeuroEngineering Rehabil

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Background Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. Methods An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months. Results Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. Conclusions This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016)

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Section: Discussionsupporting

confidence: 84%

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

Louie

Durocher

Schneeberg

et al. 2021

J NeuroEngineering Rehabil

Self Cite

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“…Only three studies [ 28 , 34 , 42 ] provided information on the participants’ ethnic background, with participants identifying as White, Black, Asian, Hispanic/Latinx or multiracial. The sample consisted of patients undertaking or who had undertaken in the past robotic therapy (n = 255) [ 25 – 27 , 34 , 35 , 37 , 39 , 41 – 43 , 45 – 49 , 51 , 52 , 54 , 57 , 58 ], parents (n = 11) [ 34 , 39 ] or other carers (n = 8; the paper does not specify the carers’ relationships to the patients) [ 57 ], as well as healthcare professionals (n = 119), including physiotherapists or occupational therapists (n = 108) [ 28 , 29 , 35 , 36 , 38 , 40 , 44 , 46 , 49 , 50 , 53 – 56 , 58 ], doctors (n = 7) [ 54 ], nurses (n = 2) [ 54 ], and non-medical personnel (n = 2) [ 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies included patients (or their carers or their healthcare professionals) who had received rehabilitation after stroke (15 studies) [ 29 , 35 , 36 , 40 , 41 , 43 , 47 , 49 – 53 , 55 , 57 , 58 ], or brain and/or spinal cord injury (8 studies) [ 25 , 26 , 28 , 29 , 37 , 38 , 42 , 45 ]. One study included children with cerebral palsy and their parents [ 39 ] and a second study [ 34 ] included only the parents of children with cerebral palsy.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies involved upper limb (10 studies) [ 35 , 36 , 47 – 52 , 55 , 57 ] or walking/standing/gait rehabilitation (14 studies) [ 25 – 29 , 34 , 38 – 42 , 44 , 45 , 54 ]. One study [ 37 ] involved lower limb rehabilitation, one study [ 53 ] focused specifically on wrist and hand rehabilitation, one study [ 46 ] targeted rotator cuff muscles, whereas two [ 43 , 56 ] focused on upper and/or lower limb rehabilitation.…”

Section: Resultsmentioning

confidence: 99%

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Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta-synthesis

Laparidou

Curtis

Akanuwe

et al. 2021

J NeuroEngineering Rehabil

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Background In recent years, robotic rehabilitation devices have often been used for motor training. However, to date, no systematic reviews of qualitative studies exploring the end-user experiences of robotic devices in motor rehabilitation have been published. The aim of this study was to review end-users’ (patients, carers and healthcare professionals) experiences with robotic devices in motor rehabilitation, by conducting a systematic review and thematic meta-synthesis of qualitative studies concerning the users’ experiences with such robotic devices. Methods Qualitative studies and mixed-methods studies with a qualitative element were eligible for inclusion. Nine electronic databases were searched from inception to August 2020, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. Results The search strategy identified a total of 13,556 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 30 studies were included. All studies were considered of acceptable quality. We developed six analytical themes: logistic barriers; technological challenges; appeal and engagement; supportive interactions and relationships; benefits for physical, psychological, and social function(ing); and expanding and sustaining therapeutic options. Conclusions Despite experiencing technological and logistic challenges, participants found robotic devices acceptable, useful and beneficial (physically, psychologically, and socially), as well as fun and interesting. Having supportive relationships with significant others and positive therapeutic relationships with healthcare staff were considered the foundation for successful rehabilitation and recovery.

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“…With continuing advancements in mechanical design, modern materials, improved power sources, miniaturization of electronics, increased rate of data processing, and better understanding of biomechanics, widespread adoption of wearable robots seems to be within reach. Nevertheless, despite all these scientific and technological advancements, many recent pioneering efforts to bring wearable robots to real-life applications were accompanied by mixed feelings of those who were supposed to benefit from them (Hensel and Keil, 2019;Davis et al, 2020;Mortenson et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Challenges and solutions for application and wider adoption of wearable robots

et al. 2021

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The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human–robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots.

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Therapists’ experience of training and implementing an exoskeleton in a rehabilitation centre

Cited by 26 publications

References 27 publications

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta-synthesis

Challenges and solutions for application and wider adoption of wearable robots

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