Acceptance of Enhanced Robotic Assistance Systems in People With Amyotrophic Lateral Sclerosis–Associated Motor Impairment: Observational Online Study

Background: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by a progressive paresis of the extremities and the loss of manual functioning. Due to the severe functional impairment that the disease entails, ALS requires the provision of comprehensive nursing care and a complex set of assistive technology devices. To relieve caregivers and promote autonomy of people with ALS, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology, in general, and of robotic arm assistance among people with ALS in order to lay the groundwork for the development of a semiautomatic robotic arm that can be controlled by humans via a multimodal user interface and that will allow users to handle objects and attend to their own bodies. Objective: The aim of this study was to perform a systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited people living with ALS. Methods: The investigation was conducted as a study of a prospective cohort. Participants were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie internet platform. Technological commitment was measured using the Neyer short scale. Furthermore, a multidimensional questionnaire was specially developed to analyze participant acceptance of robotic arm assistance: the Acceptance Measure of Robotic Arm Assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the ALS Functional Rating Scale–Extended (ALSFRS-EX). Results: A total of 268 people with ALS participated in the survey. Two-thirds of the participants were male. The overall mean ALS severity score was 42.9 (SD 11.7) points out of 60 on the ALSFRS-EX, with the most relevant restrictions on arms and legs (<60% of normal functioning). Technological commitment ranked high, with the top third scoring 47.2 points out of 60. Younger participants and males showed significantly higher values. The AMRAA score was, again, significantly higher among younger participants. However, the gender difference within the overall cohort was not significant. The more limited the arm functioning of participants according to the ALSFRS-EX subscale, the higher the acceptance rate of robotic assistance. This relationship proved significant. Conclusions: People with ALS display high technological commitment and feel positive about using technological assistance systems. In our study, younger participants were more open to technology use, in general, and robotic assistance, in particular. Self-appraisal of technology acceptance, competence, and control conviction were generally higher among men. However, any presumed gender difference vanished when users were asked to rate the anticipated usefulness of the technology, in particular the robotic arm. The acceptance was also reflected in users’ increased willingness to use a robotic arm as the functionality of their own arms decreased. From the perspective of people with ALS, robotic assistance systems are critical to promoting individual autonomy. Another key consideration in the development of future assistive technologies should be the reduction of caregiver burden. Trial Registration: German Clinical Trials Register DRKS00012803; https://tinyurl.com/w9yzduh

État des connaissances sur les fauteuils roulants motorisés intelligents (FRMIs) et recommandations pour la poursuite de leur développement : un examen de la portée

Contexte : La participation sociale d’utilisateurs de fauteuils roulants peut être affectée par certains facteurs, tels que l’accessibilité et les caractéristiques individuelles de ces derniers, pouvant limiter leur pleine implication dans la réalisation des activités signifiantes de la vie quotidienne. Afin d’améliorer leur mobilité, différents prototypes de fauteuils roulants motorisés intelligents (FRMIs) sont en développement, à l’intention de personnes présentant des déficiences physiques, cognitives ou sensorielles, et qui sont dans l’incapacité d’utiliser un fauteuil roulant motorisé (FRM). Le but visé est de leur procurer davantage d’autonomie dans leurs déplacements, et tenter ainsi de répondre à leurs besoins en termes de mobilité et de participation sociale. Objectif : Explorer la littérature portant sur le développement de FRMIs afin de comprendre dans quelle mesure les prototypes existants répondent aux besoins réels des utilisateurs, d’identifier les limites des études, et de faire des recommandations pour mieux orienter le développement continu des FRMIs. Méthodologie : Un examen de la portée a été réalisé suivant les six étapes proposées par Arskeys et O’Malley (2005), puis bonifiées par Levac et al. (2010). Les études publiées en anglais ou en français, jusqu’à septembre 2020, ont été consultées. Résultats : Au total, 41 études ont été retenues pour l’analyse. Les résultats suggèrent que les différentes technologies intégrées aux FRMIs pourraient contribuer à répondre à certains besoins d’utilisateurs présentant différentes incapacités, contribuer à améliorer leur mobilité, procurer de l’autonomie et favoriser leur participation sociale. Par ailleurs, des résultats complémentaires ont permis d’identifier : (a) d’autres technologies, pouvant favoriser davantage le sentiment d’autonomie et de confort aux utilisateurs, et (b) d’autres usages possibles du FRMI en clinique. Une limite importante identifiée est l’absence d’études expérimentales pouvant permettre d’évaluer l’efficacité du FRMI. Le point de vue des proches-aidants est également peu rapporté dans la littérature. Conclusion : Des études futures seraient à envisager en vue d’améliorer les prototypes de FRMIs existants.Background: The level of social participation among wheelchair users can be affected by factors such as accessibility, as well as their individual clinical profile, which can limit their full involvement in meaningful activities of daily living. To meet their needs in terms of mobility and social participation, different prototypes of intelligent powered wheelchairs (IPW) are being developed, in order to improve the mobility of people with physical, cognitive or sensorial impairments, who have difficulties using standard powered wheelchairs. Objective: The aim of this study was to map the existing literature on the nature of studies carried out on IPWs to better understand how the existing IPWs meet the needs of powered wheelchair users, and to better guide the ongoing development of IPWs. Methods: A scoping review was conducted in accordance with the six stages of Arskeys and O’Malley’s (2005) framework which was later enhanced by Levac et al. (2010). All studies available until September 2020, written in English or in French, were included. Results: A total of 41 studies were included in the scoping review. The results suggest that the various technologies integrated into IPWs could meet some of the needs of powered wheelchair users (PWu), could help improve mobility, provide independence, and promote social participation of some PWu. Moreover, additional results were identified: (a) other technologies, that could provide more independence and comfort to users, and (b) other clinical uses of IPW. An important limitation of the literature is the lack of experimental studies that could help assessing the efficiency of IPW. The point of view of caregivers is also less reported in the literature. Conclusion: Further studies should be considered to improve the functioning of the existing prototypes of IPW