Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review

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Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review

 

• C. Cumplido-Trasmonte,
• F. Molina-Rueda,
• G. Puyuelo-Quintana,
• A. Plaza-Flores,
• M. Hernández-Melero,
• E. Barquín-Santos,
• MA. Destarac-Eguizabal &
• E. García-Armada 

Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 47 (2023) Cite this article

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Abstract

Background

People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons.

Methods

A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons.

Results

Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists.

Conclusion

Users’ satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users’ point of view are ease of adjustment, size and weight, and ease of use.

Background

Stroke, spinal cord injury (SCI), multiple sclerosis (MS), Parkinson or cerebral palsy (CP) are some of the main causes of paresis around the world [1]. Lack of mobility and loss of independence to perform basic activities of daily living limit patients to a sedentary lifestyle, increasing the likelihood of chronic diseases [2]. Gait recovery in people with neurological disorders has a significant impact on quality of life and gait training is a relevant target of rehabilitation [3, 4].

In recent years, with the advent of improved electro-mechanical technology, faster data processing and the reduction of equipment size, exoskeletons have emerged as a new option in the field of rehabilitation that can enable walking around the environment [5]. Recent technology developments make overground gait exoskeletons increasingly available to rehabilitation facilities and patients with gait disorders. These technological innovations have become an alternative to manual gait rehabilitation [6]. Compared to conventional therapy, robotic gait rehabilitation can offer highly controlled, repetitive and intensive training in an engaging environment, reducing the physical burden on the therapist and providing objective and quantitative assessments of patient progression [7].

Currently, there are two types of exoskeletons for walking assistance in people with neurological pathology: body-weight-supported treadmill training (BWSTT) exoskeletons and overground exoskeletons [6, 8]. BWSTT exoskeletons included treadmill gait training, while overground exoskeletons included gait training that involved moving across the floor with or without body-weight support [9]. Recent narrative reviews [5, 10] of overground exoskeletons describe the current state of the art with device-specific features and limitations. Overground exoskeletons are emerging as revolutionary devices for gait rehabilitation due to the active participation required from the patient, which promotes physical activity [3, 11, 12], and the possibility of being used as an assistive device in the community [13]. Therefore, it is expected that the exoskeletons will be further developed to be used as a mobility device in the daily life by people with gait disorders [14].

Satisfaction can be defined as the extent to which the user’s physical, cognitive and emotional responses that result from the use of a system, product or service meet the user’s needs and expectations [15]. As research on wearable robotic exoskeletons in rehabilitation facilities has increased, recent studies have assessed patient and therapist satisfaction with the therapy. However, some studies refer that only 8% of the scientific literature regarding robotic exoskeletons has included considerations of patient satisfaction [16,17,18]. Considering that the satisfaction of an assistive device is highly dependent on the user’s perspective [19, 20], it is surprising that little research has focused on participant perceptions of these powered exoskeletons and their learning process [16,17,18]. Assessing overall patients and therapists satisfaction can help measure the aggregate quality of a product/service [21] and tracking patient satisfaction can help developers and researchers to improve the product/service for users. In patient engagement management, satisfaction is the extent to which a product/service meets patients’ expectations [22]. Focusing on the health care sector, quality of care and patient satisfaction are major issues [23]. Therefore, the evaluation of any device/service from patient’s and professional’s perspective is crucial [24,25,26].

In response to this lack of information about gait exoskeletons satisfaction, this paper aimed to systematically review the literature to assess the evidence concerning gait exoskeleton satisfaction in people with neurological pathology. The specific objectives are to: [1] Assess the satisfaction of gait overground exoskeleton interventions for people with neurological pathology and [2]: Describe the exoskeleton, participants and methodology used to assess satisfaction in this population. To the best of our knowledge, no such research has previously been carried out or published.

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