Within- and between-therapist agreement on personalized parameters for robot-assisted gait therapy: the challenge of adjusting robotic assistance

Journal of NeuroEngineering and Rehabilitation

Research

Florian van Dellen¹  T. Aurich-Schuler²  Rob Labruyère² 

[1] Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland;Swiss Children’s Rehab, University Children’s Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern Am Albis, Switzerland;Children’s Research Center, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland;Swiss Children’s Rehab, University Children’s Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern Am Albis, Switzerland;Children’s Research Center, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland;

关键词: Bodyweight support;    Gait speed;    Guidance force;    Path control;    Exoskeleton;    Therapist decision making;   

DOI  :  10.1186/s12984-023-01176-x

 received in 2022-11-17, accepted in 2023-04-19,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundStationary robotic gait trainers usually allow for adjustment of training parameters, including gait speed, body weight support and robotic assistance, to personalize therapy. Consequently, therapists personalize parameter settings to pursue a relevant therapy goal for each patient. Previous work has shown that the choice of parameters influences the behavior of patients. At the same time, randomized clinical trials usually do not report the applied settings and do not consider them in the interpretation of their results. The choice of adequate parameter settings therefore remains one of the major challenges that therapists face in everyday clinical practice. For therapy to be most effective, personalization should ideally result in repeatable parameter settings for repeatable therapy situations, irrespective of the therapist who adjusts the parameters. This has not yet been investigated. Therefore, the aim of the present study was to investigate the agreement of parameter settings from session to session within a therapist and between two different therapists in children and adolescents undergoing robot-assisted gait training.Methods and resultsFourteen patients walked in the robotic gait trainer Lokomat on 2 days. Two therapists from a pool of 5 therapists independently personalized gait speed, bodyweight support and robotic assistance for a moderately and a vigorously intensive therapy task. There was a very high agreement within and between therapists for the parameters gait speed and bodyweight support, but a substantially lower agreement for robotic assistance.ConclusionThese findings imply that therapists perform consistently at setting parameters that have a very clear and visible clinical effect (e.g. walking speed and bodyweight support). However, they have more difficulties with robotic assistance, which has a more ambiguous effect because patients may respond differently to changes. Future work should therefore focus on better understanding patient reactions to changes in robotic assistance and especially on how instructions can be employed to steer these reactions. To improve the agreement, we propose that therapists link their choice of robotic assistance to the individual therapy goals of the patients and closely guide the patients during walking with instructions.

【 授权许可】

CC BY   
© The Author(s) 2023

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