On the role of visual feedback and physiotherapist‑patient interaction in robot‑assisted gait training: an eye‑tracking and HD‑EEG study

Journal of NeuroEngineering and Rehabilitation, 2024 · DOI: https://doi.org/10.1186/s12984-024-01504-9 · Published: December 3, 2024

Spinal Cord Injury Neurorehabilitation Rehabilitation

Simple Explanation

This study explores how visual feedback and the interaction between a physiotherapist and patient affect a patient's focus and emotional state during robot-assisted gait training. The research combines eye-tracking and EEG measurements to understand patient engagement. Ten individuals with Spinal Cord Injury (SCI) participated in robot-assisted gait training sessions using different types of visual feedback (chart, emoticon, game) and levels of therapist interaction (low, medium, high). Eye movements and brain activity were monitored to assess attention and engagement. The findings suggest that both the type of visual feedback and the level of therapist support significantly influence a patient's engagement. More game-like feedback requires less therapist involvement, while simpler feedback types benefit from greater therapist interaction.

Study Duration

2 weeks

Participants

10 individuals with incomplete Spinal Cord Injury (C or D ASIA Impairment Scale level)

Evidence Level

Not specified

Key Findings

1
The type of visual feedback significantly affects all eye-tracking metrics across monitor, physiotherapist, and surrounding areas of interest.
2
The level of physiotherapist-patient interaction, combined with feedback type, impacts eye-tracking metrics specifically in the physiotherapist and surrounding areas.
3
High physiotherapist-patient interaction levels activate brain regions related to social cognition, whereas low interaction activates the insula, regardless of the feedback type.

Research Summary

This study investigated the impact of visual feedback type and physiotherapist-patient interaction level on patient engagement during robot-assisted gait training (t-RAGT) using eye-tracking (ET) and electroencephalography (EEG). The results indicate that both the type of feedback and the level of interaction significantly influence patient's visual attention and brain activity, with game-like feedback requiring less therapist involvement and simpler feedback benefiting from greater interaction. The findings suggest that the physiotherapist plays a crucial role in the rehabilitation process, complementing the human-robot dyadic relationship and promoting a richer therapist-mediated human-robot interaction in RAGT.

Practical Implications

Personalized Rehabilitation Protocols

Tailor t-RAGT protocols by considering the type of visual feedback and the level of physiotherapist interaction to optimize patient engagement.

Enhanced Therapist Role

Emphasize the active role of the physiotherapist in guiding patients during robot-assisted therapy, especially when using less intuitive feedback methods.

Gamification in Rehabilitation

Leverage game-like feedback to enhance patient motivation and reduce perceived mental and physical workload during t-RAGT.

Study Limitations

1
Small sample size limits the generalizability of the findings.
2
Lack of measurements regarding the actual patient’s physical exertion during t-RAGT.
3
The study did not assess the impact of different types of visual FB on patients’ rehabilitation outcome.

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