Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art”

Esquenazi, Alberto

doi:10.1155/2018/7634965

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…We know little about the budget impact of integrating RTexo devices into routine therapy services. Carpino et al conducted a review and model-based cost-effectiveness analysis of lower extremity robotics, showing RT-exo to be cost-effective relative to conventional care and stationary robotics; however, model assumptions have been criticized [32]. Morrison performed an analysis of the financial feasibility of lower extremity robotics, but did not address exoskeletal devices [33].…”

Section: Budget Impact Analysisframeworkmentioning

confidence: 99%

Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems

Pinto

Garnier

Barbas

et al. 2020

J NeuroEngineering Rehabil

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Background We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. Methods A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. Results Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226–397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to $4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. Conclusions Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions.

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Section: Budget Impact Analysisframeworkmentioning

confidence: 99%

Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems

Pinto

Garnier

Barbas

et al. 2020

J NeuroEngineering Rehabil

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“…The C# program ran on a laptop (windows 10, i7 core with no GPU), which controlled the timing of the auditory cues played from the computer and interfaced with MATLAB. The coefficients of the gait parameter estimation algorithm, CDS, were initialized as the following: M = 7, µ = 0.1, η = 1, φ 0 = 0, ω 0 = 2π • 4 5 , α m,0 = 0 for all α m , and β m,0 = 0 for all β m . C. Experimental Conditions There were a total of 7 experimental conditions (1 control and 6 levels) in the study.…”

Section: B Materialsmentioning

confidence: 99%

“…LokoMat and ReWalk [3]), capable of monitoring the patient's joint motion in real time and providing assistive torques to guide the movement of the patient [1]. The high cost of exoskeletons, ranging from $35,000 USD to $400,000 USD [4], can be prohibitive for patients to use in their daily lives. For patients who do not require load-bearing assistance, an alternative to exoskeletons are wearable devices that can provide simple feedback such as visual, auditory, and tactile cues to help patients both during therapy and in their daily activities [1], [5].…”

Section: Introductionmentioning

confidence: 99%

“…These cue provision paradigms have several limitations that are particularly problematic for long-term use and diseases with progressive symptoms such as PD. For instance, the cueing mechanisms are often used in conjunction with medications for PD treatment, and the same patient can respond differently to 1 Tina and 4 Dana are with the Department of Electrical and Computer Engineering, Monash University, Australia 2 Anna is with the Clinical Research Centre for Movement Disorders and Gait, Monash Health, Australia 3 Chao is with the Department of Mechanical and Aerospace Engineering, Monash University, Australia Corresponding author: lee.wu@monash.edu 1 the cues depending on the medication state [5]. In addition, long-term use of the cues can result in habituation, where the cues become less salient and lose their effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Human-in-the-loop Auditory Cueing Strategy for Gait Modification

Wu,

Murphy,

Chen

et al. 2020

Preprint

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External feedback in the form of visual, auditory and tactile cues has been used to assist patients to overcome mobility challenges. However, these cues can become less effective over time. There is limited research on adapting cues to account for inter and intra-personal variations in cue responsiveness. We propose a cue-provision framework that consists of a gait performance monitoring algorithm and an adaptive cueing strategy to improve gait performance. The proposed approach learns a model of the person's response to cues using Gaussian Process regression. The model is then used within an online optimization algorithm to generate cues to improve gait performance. We conduct a study with healthy participants to evaluate the ability of the adaptive cueing strategy to influence human gait, and compare its effectiveness to two other cueing approaches: the standard fixed cue approach and a proportional cue approach. The results show that adaptive cueing is more effective in changing the person's gait state once the response model is learned compared to the other methods.

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“…The authors have analysed the comments by Alberto Esquenazi [1] on their article “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art” [2]. The authors believe that the investigated topic, and assessment studies on medical devices generally, is a debated theme since the scientific evidence is sparse and the attempts to collect information are challenging.…”

mentioning

confidence: 99%

Response to: Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art”

Carpino

Pezzola

Urbano

et al. 2019

Journal of Healthcare Engineering

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Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art”

Cited by 9 publications

References 14 publications

Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems

Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems

Human-in-the-loop Auditory Cueing Strategy for Gait Modification

Response to: Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art”

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