Highly intensive technology-assisted training (TAT) involving new technologies
Technological devices were chosen with the prerequisite to provide feedback and allow a targeted, intensive, and dense training.
A broad range of available technological systems were used in the intervention, including VR-based, electromechanically assisted and sensor-based devices for gait, upper, and lower extremity training. The selection of therapy devices depended on the impairments of the patient and resources of the clinic. The following devices were used (in alphabetical order): Allegro Medical Device (Dynamic Devices, Zürich, Switzerland), Amadeo (tyromotion, Graz, Austria), Andago (Hocoma AG, Volketswil, Switzerland), Armeo Boom, Armeo Power and Armeo Spring (Hocoma AG, Volketswil, Switzerland), Bi-Manu-Trainer (Reha-Stim Medtec AG, Schlieren, Switzerland), C-Mill (c-mill-technologie AG, Port, Switzerland), EksoGT (EkSo Bionics, Richmond, USA), Erigo (Hocoma AG, Volketswil, Switzerland), FLOAT (Reha-Stim Medtec AG, Schlieren, Switzerland), Gloreha (Idrogenet srl, Lumezzane, Italy), HAL (Cyberdyne Inc, Tsukuba, Japan), Lokomat (Hocoma AG, Volketswil, Switzerland), mindmaze (MindMaze, Lausanne, Switzerland), MOTOmed (Reck, Betzenweiler, Germany), Myro (tyromotion, Graz, Austria), NuStep (NuStep LLC, Ann Arbor, USA), and Valedo Motion (Hocoma AG, Volketswil, Switzerland)
The training was supervised or guided by an officially recognized physiotherapist, occupational therapist, or sports scientist/therapist holding a BSc or MSc degree. All therapists were specially trained in the use of the devices and experienced in treating neurological patients.
The ratio of patient to therapist was between 1:1 and 3:1. Safety for patients was ensured at all time.
The training took place in one of the four participating rehabilitation centers.
When and how much
A training series lasted 4 weeks and comprised 3 to 5 training days per week. One training day included at least five trainings with a duration of 45 min per training.
Patients’ goals and preferences were incorporated. Patients received a tailored training plan based on the patient’s needs, impairments, and preferences. Absolute and relative contraindications for the training with any of the respective devices were considered. Training sessions were intensified by increasing exercise duration, resistance or complexity of the exercise.
A maximum training break of 7 days was tolerated. If the maximal program (5 sessions/day) could not be tolerated by patients or due to scheduling reasons, a reduction of training intensity in terms of days, sessions/day, and/or duration of a session was considered.