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Høyer E1, Lannem AM2, Jørgensen V2
1Sunnaas Rehabilitation Hospital HF, Competence Unit/ Stroke Department, Nesoddtangen, Norway, 2Sunnaas Rehabilitation Hospital, Research Department, Nesoddtangen, Norway
Background: Research on exoskeleton robots for gait training in patients with neurological gait disorders within rehabilitation has increased over the last few years. This has provided valuable insight in aspects like safety and feasibility of the equipment, and patient and therapist satisfaction when using robotic assistive technology. However, the transition into clinical practice still seems a challenge. In order to meet this challenge at our hospital, the implementation of Ekso GTTM for gait training was organized as a development project.
Purpose: The following questions were addressed:
1) Does robot assisted gait training function within an ordinary clinical rehabilitation setting in patients after stroke? and
2) What are the experiences with Ekso GTTM exoskeleton for patients after stroke?
Methods: An explorative study design was used. All inpatients with gait disability after stroke were screened for possible participation in training with the robot Ekso GTTM, from August 2017 to July 2018. Approval from a medical doctor and a signed informed consent were collected. Included were patients who fulfilled the inclusion and screening criteria from Ekso Bionics, were able to be upright in a standing frame, could follow instructions and collaborate, and could participate in training over minimum three weeks. The training was conducted two to three times per week, and each session lasted one hour including mounting and remounting the robot. A certified physiotherapist led the training with assistance from assistive personnel. Assessments included: Demographic data, Motor Assessment Scale, MAS, total score (0-48), Ekso software walking data, patient`s perception of satisfaction and usefulness of the training sessions, Likert scale (1-5), and evaluation of perceived exertion, Borg scale (6-20). Statistical Package for Social Sciences, SPSS version 23, was used for analyses of descriptive data and Wilcoxon Signed Ranks Test for nonparametric data.
Results: Twenty patients participated, 6 women and 14 men. Median age was 52 (min-max 17-68) years. Type of stroke was 9 infarcts and 11 hemorrhages. Robot assisted gait training worked satisfactory within ordinary rehabilitation. The training started median 3 months (IQR1.5-4) after stroke. Median number of training sessions per patient (n=19) was 7.5 (IQR 4.0-10.75). Median MAS changed significant from 15 (IQR 9.5-21.0) before to 19 (IQR 15.5-30.0) after training (p 0.003). Statistical significant changes were found in walking time (p 0.01), up-time (p 0.01) and number of steps (p 0.004) between start (3. session) and the end of training. The patients reported a median score of 11.5 (IQR 9.0-13.75) on Borg scale, indicating a quite easy perceived exertion. Fifteen (of 16) reported a high level of satisfaction and 13 (of 16) a high level of usefulness of the training, both with median scores of 5 (IQR 4-5). No disadvantages were experienced in 10 (of 16) patients. Twelve out of 16 patients would like to repeat this training method if offered.
Conclusion(s): Ekso GTTM can be safely implemented in ordinary clinical rehabilitation under the prerequisite of a structured organization and certified personnel. The patients progressed in all outcome measures.
Implications: Ekso GTTM can work as an aid in ordinary clinical gait rehabilitation.
Keywords: Exoskeleton, Stroke, Implementation
Funding acknowledgements: No funding was required. The project was part of clinical rehabilitation at Sunnaas Rehabilitation Hospital.
Purpose: The following questions were addressed:
1) Does robot assisted gait training function within an ordinary clinical rehabilitation setting in patients after stroke? and
2) What are the experiences with Ekso GTTM exoskeleton for patients after stroke?
Methods: An explorative study design was used. All inpatients with gait disability after stroke were screened for possible participation in training with the robot Ekso GTTM, from August 2017 to July 2018. Approval from a medical doctor and a signed informed consent were collected. Included were patients who fulfilled the inclusion and screening criteria from Ekso Bionics, were able to be upright in a standing frame, could follow instructions and collaborate, and could participate in training over minimum three weeks. The training was conducted two to three times per week, and each session lasted one hour including mounting and remounting the robot. A certified physiotherapist led the training with assistance from assistive personnel. Assessments included: Demographic data, Motor Assessment Scale, MAS, total score (0-48), Ekso software walking data, patient`s perception of satisfaction and usefulness of the training sessions, Likert scale (1-5), and evaluation of perceived exertion, Borg scale (6-20). Statistical Package for Social Sciences, SPSS version 23, was used for analyses of descriptive data and Wilcoxon Signed Ranks Test for nonparametric data.
Results: Twenty patients participated, 6 women and 14 men. Median age was 52 (min-max 17-68) years. Type of stroke was 9 infarcts and 11 hemorrhages. Robot assisted gait training worked satisfactory within ordinary rehabilitation. The training started median 3 months (IQR1.5-4) after stroke. Median number of training sessions per patient (n=19) was 7.5 (IQR 4.0-10.75). Median MAS changed significant from 15 (IQR 9.5-21.0) before to 19 (IQR 15.5-30.0) after training (p 0.003). Statistical significant changes were found in walking time (p 0.01), up-time (p 0.01) and number of steps (p 0.004) between start (3. session) and the end of training. The patients reported a median score of 11.5 (IQR 9.0-13.75) on Borg scale, indicating a quite easy perceived exertion. Fifteen (of 16) reported a high level of satisfaction and 13 (of 16) a high level of usefulness of the training, both with median scores of 5 (IQR 4-5). No disadvantages were experienced in 10 (of 16) patients. Twelve out of 16 patients would like to repeat this training method if offered.
Conclusion(s): Ekso GTTM can be safely implemented in ordinary clinical rehabilitation under the prerequisite of a structured organization and certified personnel. The patients progressed in all outcome measures.
Implications: Ekso GTTM can work as an aid in ordinary clinical gait rehabilitation.
Keywords: Exoskeleton, Stroke, Implementation
Funding acknowledgements: No funding was required. The project was part of clinical rehabilitation at Sunnaas Rehabilitation Hospital.
Topic: Neurology: stroke; Neurology: stroke; Disability & rehabilitation
Ethics approval required: Yes
Institution: Sunnaas Rehabilitation Hospital
Ethics committee: Email: [email protected]
Ethics number: 2017/2258
All authors, affiliations and abstracts have been published as submitted.
