Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists.
Julie Vaughan-Graham, Dina Brooks, Lowell Rose and 3 others
PMID 32912215WHAT IT FOUND
Both stroke survivors and physiotherapists rejected the exoskeleton's pre-programmed gait, wanting a device that assists their own movement rather than walking for them.
Fitting took 30-40 minutes and required two people to support each patient, raising concerns about therapy time and safety.
Key findings
01Stroke survivors and physiotherapists both preferred an augmentative device that adjusts to the patient's own gait pattern over a robot that imposes a pre-programmed walking pattern.
02Fitting the exoskeleton took 30 to 40 minutes, and every participant required manual support from two people for the entire walking session, which clinicians identified as a significant barrier to clinical uptake.
03Physiotherapists raised safety concerns that the device interfered with weight transfer and balance, and questioned its suitability for patients with poor standing tolerance, atypical muscle tone, or cognitive deficits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only five stroke survivors and six physiotherapists were interviewed, all from private community clinics in one city, so the perspectives may not represent public or acute care settings. All participants had a single-use experience. The findings describe first impressions, not the experience of using the device over a course of treatment. Interviews took place 5 to 10 days after the session, which may have affected the accuracy of recall. The stroke survivors in this study were relatively high-functioning: all could walk for six minutes with or without one person's assistance, and none had receptive aphasia. The findings say nothing about patients with more severe impairments.
Declared interests
The study was funded by the Heart and Stroke Foundation of Canada and an EMH Seed Grant. No commercial exoskeleton manufacturer is listed as a funder.
The easy way to misread this
Do not read the participants' interest in the technology as evidence that exoskeletons improve walking after stroke. This study reports opinions after a single use session. No gait outcomes were measured, and the primary finding is that both patients and therapists identified substantial usability and safety barriers that currently prevent clinical integration.