Physiological and Perceptual Demand of Overground Robotic Exoskeleton Gait Training on Physical Therapists in the Inpatient Neurorehabilitation Setting

Research Objectives: To describe the physiological and perceptual burden of gait training using overground robotic exoskeletons (ORE) and usual care (UC) approaches on physical therapists (PT) during inpatient neurorehabilitation.

Design: Single-center, observational, consecutive cohort design

Setting: Inpatient rehabilitation hospital

Participants: ORE-certified inpatient neurorehabilitation PT

Interventions: PT conducted two gait training sessions (once with ORE and once with UC approach) while physiological and perceptual burden was assessed.

Main Outcome Measures: Physiological burden {VO2 and metabolic equivalents [METs; low ( < 3), moderate (3-5.9), vigorous (>6)], and heart rate [HR; percent of age-predicted max ‘very light’ (50-60%), ‘light’ (60-70%), ‘moderate’ (70-80%), ‘hard’/‘near maximal’ (>80%)]} were measured using a wearable metabolic cart (K5, COSMED) and HR monitor (HRM Dual, Garmin Ltd). Perceptual burden [demand (mental, physical, temporal), performance, effort, and frustration] was assessed using domain scores (ratings between 0=none and 20=high burden) of the NASA Task Load Index.

Results: PT (n=4) were female, age 37.8±4.3 years, non-Hispanic, 50% White, with 11.5±4.5 years of experience. Physiological burden during ORE was VO2=13.4±1.7 mL/min/kg, METS=3.83±0.5, with 17.4±14.8% of the session spent at low, 82.6±14.8% at moderate, and 0% at high intensity. Physiological burden was higher during UC, VO2=16.23±2.1 mL/min/kg, METs=4.6±0.6, with 14.9±11.4% of the session spent at low, 60.9±38.2% at moderate, and 24.3±27.3% spent at high intensity. ORE HR outcomes [mean=111±19.4 bpm, peak=123±20.2 bpm, recovery=115±24.8 bpm] were lower than UC [average=121.5±17.7 bpm, peak=144.3±19.7 bpm, recovery=128±25.5 bpm]. In ORE, session time was ‘very light’=56.1±46.8%, ‘light’=22.2±28.8%, ‘moderate’=10.9±21.8%, and ‘hard’/‘near maximal’=10.9±21.8% compared to UC [‘very light’=35.4±39.3%,‘light’=20.2±11.4%, ‘moderate’=30.6±20.8%, ‘hard’/‘near maximal’=13.9±18.4%]. ORE perceptual burden of outcomes included demand (mental=8.6±4.9, physical=10±1.8, temporal=4.3±3.6), performance=7.3±5.9, effort=9.8±3.9, and frustration=3.5±2.5 were lower than UC (mental=11.8±4.6, physical=17±2.9, temporal=10.8±6.2; performance=10.8±6.7; effort=15.8±1.9; frustration=5.5±2.1).

Conclusions: PT experienced lower physiological and perceptual burden using ORE than UC when delivering gait training during inpatient neurorehabilitation.

Author(s) Disclosures: None