A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

Abstract

Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which 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). 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 consider 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.

Clinical Uptake of Pediatric Exoskeletons: A Pilot Study Using the Consolidated Framework for Implementation Research

“…26 In addition, the clinicians in this study expressed a preference for using devices their clients could access at home, such as traditional gait trainers. Other studies of the uptake of neurorehabilitation technology have found therapists preferred practicing functional activities using familiar objects like toothbrushes and silverware, 6 and the unavailability of a device after discharge is a significant barrier to technology use in stroke rehabilitation. 27 While these two studies considered only therapists' perspectives, the current study also gathered data from caregivers who make decisions about their children's therapy.…”

“…11 It has been applied in various disciplines, including rehabilitation. 6,12 The CFIR consists of 39 constructs, which can be barriers or facilitators, organized into the following five domains: intervention characteristics, characteristics of individuals, inner setting, outer setting, and implementation process. The comprehensive list of constructs without pre-established hypotheses in the CFIR is preferable to an individual framework in this study because the implementation of RAGT in pediatric therapy is relatively uninvestigated.…”

ANYexo 2.0: A Fully Actuated Upper-Limb Exoskeleton for Manipulation and Joint-Oriented Training in All Stages of Rehabilitation

“…In addition, the robot should be able to provide these therapy forms meaningfully over the whole rehabilitation process, e.g., from severely affected to mildly affected [13].…”

“…Further, the robot should be well accessible for all patients, i.e., easy donning and doffing. Additionally, the attachment mechanism has to be efficient to use for the therapist and ergonomic for the patients [13] to achieve a high acceptance by the end-users. The robot should sufficiently support all human upper extremity segments to prevent excessive misalignment and pulling on joints.…”

“…Further, therapists would need less time per patient, countering the emerging therapist shortage. To maximize impact in clinical application, robots should be able to support these aspects while being applicable to provide a versatile range of neurotherapy exercises for a diverse variety of patients [11]- [13]. 0000-0000/00$00.00 © 2021 IEEE…”