Experience of Robotic Exoskeleton Use at Four Spinal Cord Injury Model Systems Centers
Experience of Robotic Exoskeleton Use at Four Spinal Cord Injury Model Systems Centers
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DOI：
10.1097/npt.0000000000000235
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发表时间：
2018-10-01
影响因子：
3.8
通讯作者：
Field-Fote, Edelle C.
中科院分区：
文献类型：
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作者：
Heinemann, Allen W.;Jayaraman, Arun;Field-Fote, Edelle C.
背景和目的：用于地面行走的机器人外骨骼的改进进展迅速。我们描述了临床医生在脊髓损伤康复和健康环境中使用机器人外骨骼的经验、评估和培训策略，并描述了临床医生对外骨骼的好处和风险的看法以及将提高实用性的进展。方法：我们在4个脊髓损伤模型系统中心召集了焦点小组。一名法庭书记员做了逐字记录，并提供了一份笔录。研究人员使用主题编码的方法来总结讨论。结果：30名临床医生参加了焦点小组。他们报告说，主要在门诊和健康环境中使用外骨骼；1个中心在住院康复期间使用外骨骼。一般的门诊外骨骼疗法包括20至30个疗程，每个疗程至少有2名工作人员参与。治疗重点是站立、步态和步态训练；治疗师通过标准化评估来衡量进展。除了改善步态，参与者还将生理、心理和社会效益归因于外骨骼的使用。潜在的风险包括跌倒、皮肤刺激和失望的期望。参与者确定了有价值的增强功能，包括更高的耐用性和适应性、更轻的重量、单手控制、在楼梯和凹凸不平的表面上导航的能力，以及在没有上肢支持的情况下保持平衡的能力。讨论和结论：每个脊髓损伤模型系统中心在如何将机器人外骨骼整合到物理治疗服务方面都有共享和独特的实践。目前几乎没有证据来指导外骨骼与康复治疗服务的整合，而且随着更多的设备进入市场，迫切需要产生证据来指导实践并告知患者的期望。
Background and Purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility.Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions.Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support.Discussion and Conclusions: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.