Robot-assisted Training for Arms Well-received by MS Patients
Feedback from participants is 'overwhelmingly positive,' study reveals
A robot-assisted training program that uses game-like activities to improve upper limb function was met with high satisfaction and enjoyment by people with multiple sclerosis (MS), a small study has found.
Most of the participants reported the intervention improved their ability to do day-to-day activities, such as using a computer, eating, or playing piano.
Physical and occupational therapy can help improve day-to-day functional abilities for people affected by MS. With new technological advancements, researchers are exploring the potential utility of using robots as a part of this type of training.
Here, scientists in Belgium aimed to assess how a robot-assisted upper limb training program was received by people with MS.
The study included 11 MS patients — six with secondary progressive MS, three with relapsing-remitting MS, and two with primary progressive disease. Their median score on the Expanded Disability Status Scale (EDSS) was 6.5, reflecting that most of the patients had noteworthy limitations in their ability to walk.
The patients had participated in a pilot clinical trial where they underwent robot-assisted training two to three times per week, for eight weeks, on the most-affected arm.
The robotic training involved having patients move their arm in order to move through virtual environments on a screen, basically making them perform arm exercises to play games. Each training session consisted of a half-hour under the supervision of a trained therapist, then another half-hour using only the robot.
Main trial results were reported in a 2017 study, and showed that the intervention improved handgrip strength, range of motion, and other measures for the MS patients.
Questionnaires and focus groups
Throughout the trial, participants completed standardized questionnaires asking about their perception and expectations regarding the intervention. After the trial, the researchers conducted focus groups where the participants could talk about their experiences. This study detailed findings from these surveys and discussions.
“The present study documented the qualitative experiences of persons participating in technology-supported rehabilitation. The patient experiences are valued, and can contribute to shape future intervention delivery methods, and ingredients of a larger” randomized clinical trial, the researchers wrote.
Results from questionnaires showed that satisfaction and enjoyment with the intervention were generally high throughout the study. Participants also reported high scores for credibility, meaning that most patients believed the intervention was helping them.
High satisfaction with the intervention also was reflected in focus group discussions. Participants said the program was easy to use, and the game-like quality instilled a sense of competition and fun into the training.
“When the participants were asked how they experienced the training sessions, feedback was overwhelmingly positive,” the researchers wrote.
Many of the participants also reported that their ability to function had improved, noting marked improvements in their arm’s endurance and strength that helped them to move the arm more easily in day-to-day life.
“Participants reported being able to eat better and being more efficient in using the mouse of the computer. One participant explained that it was now possible to carry her grandchild again, while another stated that it was easier to open jars,” the researchers wrote.
““I used to always have to help that arm to get it on the table and now it goes without saying,” said one participant. Another patient noticed being able to play piano for longer because their arms would not tire as quickly.
Only one of the 11 participants reported feeling as if he received little or no benefit from the training, reporting that his functioning was largely unchanged.
While most patients reported improvements in function during the eight-week training intervention, these benefits tended to start disappearing within a month after stopping the training. Many of the patients expressed a desire to continue similar training.
“Participants expressed the need for a long-term rehabilitation program involving robot-mediated therapy. Addressing how this could be implemented in clinical practice is essential,” the researchers concluded.
The team noted this study was limited by its small sample size, and they stressed that it is impossible from these results to make conclusions about the comparative usefulness of robot-assisted or conventional physical training regimes.