Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland.
Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, 8910, Affoltern Am Albis, Switzerland.
J Neuroeng Rehabil. 2023 Jun 20;20(1):81. doi: 10.1186/s12984-023-01176-x.
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.
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.
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.
固定式机器人步态训练器通常允许调整训练参数，包括步行速度、体重支撑和机器人辅助，以实现个体化治疗。因此，治疗师会根据每个患者的具体情况个性化设置参数。先前的研究表明，参数的选择会影响患者的行为。同时，随机临床试验通常不会报告所应用的参数设置，也不会在解释试验结果时考虑这些参数设置。因此，选择合适的参数设置仍然是治疗师在日常临床实践中面临的主要挑战之一。为了使治疗最有效，个性化治疗应理想地为可重复的治疗情况产生可重复的参数设置，而不考虑调整参数的治疗师。目前还没有对这方面进行研究。因此，本研究的目的是调查在一个治疗师和两个不同治疗师之间，儿童和青少年在接受机器人辅助步态训练时，参数设置在会话内和会话间的一致性。
14 名患者在 Lokomat 机器人步态训练器上行走了 2 天。5 名治疗师中的 2 名治疗师独立地为中度和高强度治疗任务个性化设置了步行速度、体重支撑和机器人辅助。治疗师内和治疗师间在参数步行速度和体重支撑方面具有非常高的一致性，但在机器人辅助方面一致性要低得多。
这些发现表明治疗师在设置具有非常明显和直观临床效果的参数方面表现一致（例如步行速度和体重支撑）。然而，他们在机器人辅助方面存在更多困难，因为患者对变化的反应可能不同。因此，未来的工作应该集中在更好地理解患者对机器人辅助变化的反应，特别是如何使用指令来引导这些反应。为了提高一致性，我们建议治疗师将机器人辅助的选择与患者的个体治疗目标联系起来，并在患者行走时通过指令进行密切指导。
