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Bauer C1, Nast I1, Scheermesser M1, Kuster RP2, Textor D2, Wenger M2, Baumgartner D2, Kool J3
1ZHAW, Health, Winterthur, Switzerland, 2ZHAW, School of Engineering, Winterthur, Switzerland, 3Clinic Valens, Valens, Switzerland
Background: Worldwide, around 16 million people per year experience a stroke for the first time, of which 5 million remain limited in their mobility. One cause of limited mobility early post stroke is impaired trunk function. Trunk exercises have a beneficial effect on trunk function, standing balance, and mobility. Patients post stroke whose trunk function improves faster start earlier with gait and balance training. However, safe and resource efficient therapy approaches enabling high intensity training with many repetitions early post stroke are missing.
Purpose: To overcome this gap a robot assisted trunk chair (T-Chair) that supports trunk stability and control training early post stroke is being developed. The T-Chair is designed to support two therapy goals: 1) Improving trunk control and stability and 2) facilitating standing and walking early post stroke. The aim of this study was to assess its usability in a rehabilitation setting, from a patients' and a physiotherapists' perspective.
Methods: Fifteen patients post stroke with trunk impairments and 11 physiotherapists were recruited. A moving seat to mobilise the pelvis and the lower spine is the core technology of T-chair. The seat describes a physiologic motion pattern to perform stability and balance exercises, respectively. The seat may move assisted by motors or by the patients' trunk muscles. Physiotherapists integrated the prototype T-Chair into the patients' therapy program. Each patient performed four individual therapy sessions on the prototype T-Chair under the physiotherapists' supervision. Usability from the patient's perspective was assessed using a diary and a questionnaire; usability from the physiotherapists' perspective with a focus group interview and a questionnaire. The study focused on time expenditure for preparation, safety aspects, and unsupervised therapy potential.
Results: Among physiotherapists, 64 % had a positive view of the novel therapy concept, while 33% considered the current prototype version a useful rehabilitation device. Time expenditure for preparation was rated (rather) adequate by 53% of physiotherapists and 66% of patients. In patients with very low trunk control two physiotherapists were required to transfer the patient from wheelchair to T-Chair. Physiotherapists suggested to improve safety during transfer (wheelchair to T-Chair and back). Therapists recognized the potential for unsupervised therapy. Physiotherapists expressed reservations regarding transfer for patients with low trunk-control and complexity of the software to adjust training modalities. Physiotherapist noted that the T-Chair facilitates proprioception and allows unlimited repetition of movement. Physiotherapists recommend integrating computer games into the T-Chair. Some patients reacted very positively to the T-chair and enjoyed training with it, while others found the training too undemanding.
Conclusion(s): The T-Chair might become an adequate training tool for patients post stroke at an intermediate trunk control level, between exoskeletons and bedside exercises. Improvements in time expenditure, exercise difficulty, safety, and patient transfer, as well gamification aspects are desired.
Implications: The T-Chair could become a therapeutic device to train trunk control with many repetitions early post stroke, and thus helping patients to regain mobility.
Keywords: Stroke, trunk stability and control, robot-assisted therapy
Funding acknowledgements: This work has received funding from Innosuisse under grant agreement No. 17394.3 PFLS-LS.
Purpose: To overcome this gap a robot assisted trunk chair (T-Chair) that supports trunk stability and control training early post stroke is being developed. The T-Chair is designed to support two therapy goals: 1) Improving trunk control and stability and 2) facilitating standing and walking early post stroke. The aim of this study was to assess its usability in a rehabilitation setting, from a patients' and a physiotherapists' perspective.
Methods: Fifteen patients post stroke with trunk impairments and 11 physiotherapists were recruited. A moving seat to mobilise the pelvis and the lower spine is the core technology of T-chair. The seat describes a physiologic motion pattern to perform stability and balance exercises, respectively. The seat may move assisted by motors or by the patients' trunk muscles. Physiotherapists integrated the prototype T-Chair into the patients' therapy program. Each patient performed four individual therapy sessions on the prototype T-Chair under the physiotherapists' supervision. Usability from the patient's perspective was assessed using a diary and a questionnaire; usability from the physiotherapists' perspective with a focus group interview and a questionnaire. The study focused on time expenditure for preparation, safety aspects, and unsupervised therapy potential.
Results: Among physiotherapists, 64 % had a positive view of the novel therapy concept, while 33% considered the current prototype version a useful rehabilitation device. Time expenditure for preparation was rated (rather) adequate by 53% of physiotherapists and 66% of patients. In patients with very low trunk control two physiotherapists were required to transfer the patient from wheelchair to T-Chair. Physiotherapists suggested to improve safety during transfer (wheelchair to T-Chair and back). Therapists recognized the potential for unsupervised therapy. Physiotherapists expressed reservations regarding transfer for patients with low trunk-control and complexity of the software to adjust training modalities. Physiotherapist noted that the T-Chair facilitates proprioception and allows unlimited repetition of movement. Physiotherapists recommend integrating computer games into the T-Chair. Some patients reacted very positively to the T-chair and enjoyed training with it, while others found the training too undemanding.
Conclusion(s): The T-Chair might become an adequate training tool for patients post stroke at an intermediate trunk control level, between exoskeletons and bedside exercises. Improvements in time expenditure, exercise difficulty, safety, and patient transfer, as well gamification aspects are desired.
Implications: The T-Chair could become a therapeutic device to train trunk control with many repetitions early post stroke, and thus helping patients to regain mobility.
Keywords: Stroke, trunk stability and control, robot-assisted therapy
Funding acknowledgements: This work has received funding from Innosuisse under grant agreement No. 17394.3 PFLS-LS.
Topic: Neurology: stroke; Neurology: stroke; Disability & rehabilitation
Ethics approval required: Yes
Institution: Eastern Switzerland
Ethics committee: Ethics Committee of Eastern Switzerland
Ethics number: BASEC Nr. 2017-00866
All authors, affiliations and abstracts have been published as submitted.
