by Rebecca Martin, OTR/L, OTD, and Dennis Tom-Wigfield, PT, DPT
Investment in therapeutic technologies spans a continuum from elastic bands that cost a few dollars to room-sized mobility and balance systems that require construction build-outs and additional staff. Inhabiting the middle to upper range of this continuum are robotic devices and associated technology, which have become increasingly popular. Though these advanced technologies deserve a thorough cost-benefit analysis and review of competing products prior to purchase, the payoff they may provide in outcomes and efficiency can make the investment well worth the effort.
Among the facility-based technologies that have grabbed recent headlines, robot-assisted therapy is one that may be attractive to healthcare organizations. Robot-assisted therapy is an efficacious method to remediate disability associated with a wide variety of neurological disorders, most notably stroke and spinal cord injury (SCI). Intensity and repetition has been repeatedly demonstrated to be necessary for central nervous system excitation and associated motor learning.1Massed practice, or high-volume repetition, has been shown to improve muscle strength and voluntary function.2 Robot-assisted therapy has the capacity to provide high numbers of specific movements with support or guidance as necessary, ensuring optimal conditions for motor learning and recovery of function.3 Changes can be observed in as little as 6 weeks and peak around 12 weeks of training.4
Nearly all robotic devices include some sort of computer interface, even a virtual reality component, providing the patient and therapist with real-time feedback to improve performance. Robotic devices also allow for quantitative monitoring; measuring changes in strength, range of motion, and trajectory; and illuminating patient engagement trends, time, and effort.3 As the body of literature expands and supports its use, patients are seeking clinics with these resources. Robotic technology has the potential to align patients’ interests in validated strategies with clinics’ interests in efficiency and payor-supported interventions. Clinics have an opportunity to improve patient outcomes and efficiency with which they reach those outcomes by investing in robotic devices. This investment is not trivial, however, and better understanding of the capacity and scope of different devices will help to make sure that everyone’s resources are utilized appropriately.
Assessment: Get the Complete Picture
Before it begins to investigate and trial devices, a clinic should do a careful self-assessment. Clinics should have a good understanding of their patient factors and needs: demographics, diagnoses, and payor mix. Equally important, clinics should have a good understanding of how much of their own resources—money, time, and space—they have to spend. Although money is often considered to be the limiting factor in the acquisition of technology, time and space deserve equal consideration. Nothing would be worse than investing in the perfect body weight support (BWS) gait trainer, only to find that your ceiling is too low to accommodate it. Similarly, clinics should anticipate that therapists will need time outside patient care to learn the devices and that efficiency will suffer in the early learning phase. Clinics will want to consider existing technology and therapist-driven interventions when deciding on their specific needs. Clinics would benefit from having a clear plan for acquisition and incorporation of robotic technology into existing practices. Acquiring too much technology too quickly is a sure way to reduce integration of devices and waste valuable resources.