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

van Dellen, Florian; Aurich-Schuler, Tabea; Labruyère, Rob (2023). Within- and between-therapist agreement on personalized parameters for robot-assisted gait therapy: the challenge of adjusting robotic assistance. Journal of Neuroengineering and Rehabilitation (JNER), 20(1):81.

Abstract

BACKGROUND

Stationary 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 RESULTS

Fourteen 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.

CONCLUSION

These 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.

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Rehabilitation
Health Sciences > Health Informatics
Language:English
Date:20 June 2023
Deposited On:22 Jan 2024 09:17
Last Modified:30 Oct 2024 02:41
Publisher:BioMed Central
ISSN:1743-0003
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s12984-023-01176-x
PubMed ID:37340308
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