Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

Abstract

Background Wearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton. Methods We used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton. Results Five persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use. Conclusions This study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.

“Go in with an open mind”: Perceptions of exoskeleton use during gait rehabilitation in an acute hospital setting following stroke

“…In stroke, comparative qualitative data relating to RAGT are limited and con icting. A study by Vaughan-Graham et al (2020) reported that chronic stroke survivors while hopeful about exoskeleton technology, expressed disappointment that the technology did not yet meet their expectations (22). In contrast a recent study conducted in a subacute stroke population reported positive perceptions of exoskeleton-based physiotherapy which better echoing the ndings in this study, where patients rated it favourably, attributing opportunity and bene t to using the device during subacute rehabilitation (23).…”

“…The amount of time required to record individual anthropometric measurements and t the device were identi ed as negative aspects. This limitation was mirrored in other qualitative studies examining device users' (21,22,23) and therapists' perspectives (23,29,30,31) of RAGT. However, this current study recorded only early perceptions following each participant's rst two trials of using the device where the burden of assessment and setup has previously been reported as highest (30).…”

“…However, the review included only one study speci cally focussed on gait rehabilitation after stroke (21), including only individuals in the chronic phases of stroke. Since this review, two further qualitative studies were identi ed reporting perspectives on RAGT in the chronic stage of stroke (>12 weeks) (22) and in the subacute phase following transfer to a rehabilitation centre (23). In these later stages, exoskeleton interventions are generally well-received by physical therapists and stroke survivors with expressed excitement and hopefulness about exoskeleton technology.…”

Wearable Robotic Gait Training in Persons with Multiple Sclerosis: A Satisfaction Study

“…Moderate correlations were observed between question 5 and physiotherapists’ age and years of experience in the neurorehabilitation field and with MS. The ability to adjust the exoskeleton to the patients’ needs such as the amount of assistance provided to optimize patients’ gait pattern is an essential skill for the physiotherapists [ 47 ]. The high score and the obtained correlation seem to indicate that EKSO GT ® could properly adapt to patients’ and physiotherapists’ needs.…”

An Assistive Soft Wrist Exosuit for Flexion Movements With an Ergonomic Reinforced Glove

“…Exoskeletons are physical human-robot interfaces (HRIs) conceived for several purposes such as rehabilitation, assistance, and haptic interaction in virtual or remote environments (Pons, 2008 ). The robotic community put a strong effort into developing wearable powered robots since at least 1967 (Mosher, 1967 ) when one of the earliest exoskeleton for motion augmentation was presented.…”