Tamburella Federica, Department of Life Sciences, Health and Health Professions, Link Campus University of Rome, Italye
Floriana Pichiorri, Neuroelectrical Imaging and BCI Laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
Andrea Ranieri, Neuroelectrical Imaging and BCI Laboratory, IRCCS Fondazione S. Lucia, Rome and Department of Computer, Control and Management Engineering, Sapienza University of Rome, Italy
Francesca Patarini, Neuroelectrical Imaging and BCI Laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
Giada Serratore, Spinal Center and Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, Rome; Italy
Alessandra Bigioni, Spinal Center and Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, Rome; Italy
Donatella Mattia, Neuroelectrical Imaging and BCI Laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
Giorgio Scivoletto, Spinal Center and Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
Giordano Guredda, Spinal Center and Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
Jlenia Toppi, Neuroelectrical Imaging and BCI Laboratory, IRCCS Fondazione S. Lucia, Rome and Department of Computer, Control and Management Engineering, Sapienza University of Rome, Italy
Patient’s active participation in the rehabilitation process is crucial for optimizing outcomes (Knutti K. et al., 2022). Patient’s adherence to rehabilitation plan has traditionally been mediated by the interaction with the therapist (empathy, motivation, reward) and thus by the relationship established between them along the rehabilitation pathway (Tamburella F. et al, 2017). The growing interest in robotic rehabilitation sets up to a deeper study of the role of the therapist and its robot-mediated interaction with the patient. The aim of this study was to address the therapist-patient interaction during robotic gait rehabilitation in individuals with spinal cord injury (SCI) in terms of selective attention and electroencephalography (EEG) activity.
Ten individuals with sensory-motor incomplete SCI were enrolled. The patients underwent neurological and gait-specific functional assessments at the enrollment and after the training. Training was based on 8 sessions with the Lokomat exoskeleton, the first of which consisted of a familiarization with the device for the setting of parameters to be held constant during the other sessions. In the following six sessions, 3 types of feedback (FB) (chart, smile, game FBs; 2 sessions per FB) from those available from the manufacturer were randomly administered, with patients wearing an eye-tracking system to assess their selective attention towards tree different areas: the FB Lokomat screen, the therapist, their surroundings. These sessions were timed by instructing the therapists to 3 different levels of interaction with the patient: 1) maximal interaction: explanation of the FB and its operation in a near-continuous manner; 2) medium interaction: assignment of specific tasks to the patient while limiting communication related to other aspects; 3) minimal interaction: patient free to interact with the Lokomat without therapist intervention. The last session consisted of a co-registration of eye-tracking and high-density EEG during minimum and maximum interaction levels with the 3 different FBs.
The most visited area of interest was the FB screen, regardless of the experimental condition. The therapist area was visited the most in the maximum interaction case. In the game FB, the therapist area was less visited, and this was also the mode by which less distraction (surrounding environment) was observed. In the condition of minimum interaction for the 3 types of FBs the motor areas of the lower limbs turned out to be essentially active, as the subject was focused on ambulatory training. Activations in the medial prefrontal cortex during the maximal interaction with the therapist while administering the chart FB were evidenced. The chart FB was considered the most complicated from the point of view of comprehension. A general improvement of gait performance was also reported.
Results indicate that during robotic gait rehabilitation the interaction between therapist and patient was influenced by both type of FB used and level of interaction. In particular, patient tends to fully immerse himself in the task during the game FB by minimizing the gaze direction towards the therapist. Finally, the FB chart administration maximally activates the medial prefrontal cortex, which is a key region in social interaction mechanisms.
Knutti K, Björklund Carlstedt A, Clasen R, Green D. Impacts of goal setting on engagement and rehabilitation outcomes following acquired brain injury: a systematic review of reviews. Disabil Rehabil. 2022 Jun;44(12):2581-2590. doi: 10.1080/09638288.2020.1846796. Epub 2020 Nov 19. PMID: 33211986.
Tamburella F, Moreno JC, Iosa M, Pisotta I, Cincotti F, Mattia D, Pons JL, Molinari M. Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis: a pilot study. Top Stroke Rehabil. 2017 Sep;24(6):447-456. doi: 10.1080/10749357.2017.1318340. Epub 2017 May 1. PMID: 28460597.
