Exercise Specialists Evaluation of Robot-led Physical Therapy for People with Parkinsons Disease

TL;DR

Parkinson's disease imposes motor and cognitive challenges that limit traditional PT delivery. The authors evaluate the ZEST-E robot-led PT system through a mixed-methods study with 11 Exercise Specialists, using surveys and semi-structured interviews to assess perceived efficacy, usability, and adoption barriers. Results indicate broadly positive attitudes and engagement, with actionable feedback on improving coaching quality, home-use feasibility, and safety. The work provides design guidance for scalable, patient-centered robotic rehabilitation in PD and related conditions, with potential to augment clinic throughput and home exercise adherence.

Abstract

Robot-led physical therapy (PT) offers a promising avenue to enhance the care provided by clinical exercise specialists (ES) and physical and occupational therapists to improve patients' adherence to prescribed exercises outside of a clinic, such as at home. Collaborative efforts among roboticists, ES, physical and occupational therapists, and patients are essential for developing interactive, personalized exercise systems that meet each stakeholder's needs. We conducted a user study in which 11 ES evaluated a novel robot-led PT system for people with Parkinson's disease (PD), introduced in [1], focusing on the system's perceived efficacy and acceptance. Utilizing a mixed-methods approach, including technology acceptance questionnaires, task load questionnaires, and semi-structured interviews, we gathered comprehensive insights into ES perspectives and experiences after interacting with the system. Findings reveal a broadly positive reception, which highlights the system's capacity to augment traditional PT for PD, enhance patient engagement, and ensure consistent exercise support. We also identified two key areas for improvement: incorporating more human-like feedback systems and increasing the robot's ease of use. This research emphasizes the value of incorporating robotic aids into PT for PD, offering insights that can guide the development of more effective and user-friendly rehabilitation technologies.

Figures (4)

• Figure 1: (Left) Experimental setup with an Exercise Specialist (ES) performing a seated forward kick exercise with the Zesty Exercise System for Therapeutic Engagement (ZEST-E). (Right) ZEST-E, a robotic physical therapy system with a soft bubble end effector that serves as an external cue for stretching exercises.
• Figure 2: Technology Attitudes Questionnaire rosen2013media. Positive attitude: (M = 4.3, IQR = 0.9); Negative attitude: (M = 3.0, IQR = 1.2); Anxiety: (M = 3.3, IQR = 0.2) with outliers S02 (4.3), S03 (4.0), S04 (2.7), and S05 (2.7); Task Switching: (M = 3.0, IQR = 0.6).
• Figure 3: Robot Opinions Questionnaire chen2017older (ROQ, Blue) and ZEST-E Evaluative Questionnaire (ZEQ, Green and Red). ROQ: Perceived Usefulness (PU): (M = 3.6, IQR = 1.2); Perceived Ease of Use (PEOU): (M = 4.0, IQR = 0.6) with outlier S03 (2.2); Positive Attitidue (ATT): (M = 3.0, IQR = 1.25); Intent to Use (ITU): (M = 3.5, IQR = 1.0); Perceived Enjoyment (PENJ): (M = 4.0, IQR = 1.1) with outlier S08 (1.3). ZEQ Attitudes: Usability and Interaction (USE): (M = 4.25, IQR = 1.1); Engagement and Motivation (ENG): (M = 3.8, IQR = 0.6) with outlier S08 (2.3); User Experience (UX): (M = 4.0, IQR = 0.7); Performance and Accuracy (PERF): (M = 3.7, IQR = 1.0); Therapeutic Efficacy (THER): (M = 3.6, IQR = 1.4); Operational and Environmental Considerations (OP): (M = 4.5, IQR = 1.0). ZEQ Healthcare Considerations: Usefulness in Clinic (CLINIC): (M = 4.0, IQR = 0.5) with outliers S01 (2), S02 (5), S03 (2), and S05 (5); Offloading Tasks (TASK): (M = 3.0, IQR = 1.5); Useful for Patients (PATIENT): (M = 4.0, IQR = 0.5) with outlier S03 (2); Ease of Use for Patients (EASE): (M = 4.0, IQR = 1.25); Difficult for Patients to Use (DIFF): (M = 3.0, IQR = 2.0); Exercise would be Challenging (CHALLENGE): (M = 4.0, IQR = 1.0). Response distributions from the Healthcare Provider Considerations section of the ZEQ are presented individually for each survey item.
• Figure 4: (Left) Psychosocial Impact of Assistive Devices Scale (PIADS) jutai2002psychosocial: Confidence: (M = 1.17, IQR = 0.71); Adaptability with outliers S02 (3.0) and S03 (-0.7): (M = 1.33; IQR = 1.33); Self-Esteem: (M = 1.0, IQR = 0.31) with outliers S02 (3.0), S03 (-0.4), and S06 (0.3) (Right) NASA TLX survey hart1988developmenthart2006nasa: Mental: (M = 3, IQR = 2.0); Physical: (M = 2; IQR = 1.5); Temporal: (M = 2, IQR = 2.0); Performance: (M = 4, IQR = 1.5); Effort: (M = 3, IQR = 2.0); Frustration: (M = 2, IQR = 0.0) with outliers S02 (1), S06 (3), S07 (4), and S08 (1).