Robotics in ALS – Acceptance of Enhanced Robotic Assistance Systems in Patients with ALS-Associated Motor Impairment: An Observational Online Study (Preprint)

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 of assistive technology devices. To relieve caregivers and promote patient autonomy, robotic assistance systems are being developed. This trial aims to evaluate the acceptance of technology in general and robotic arm assistance among ALS patients in order to lay the groundwork for the development of a semi-automatic robotic arm which can be controlled by patients via a multimodal user interface, and which will allow users to handle objects and attend to their own bodies. OBJECTIVE Systematic analysis of technology commitment and acceptance of robotic assistance systems from the perspective of physically limited ALS patients. METHODS The investigation was conducted as a study of a prospective cohort. Patients were only included if they had received a medical diagnosis of ALS. Data collection took place via an online questionnaire on the Ambulanzpartner Soziotechnologie (APST) Internet platform. Technological commitment was measured using the Neyer short scale (2012). Furthermore, a multidimensional questionnaire was specially developed to analyze patient acceptance of robotic arm assistance (AMRAA). This questionnaire was accompanied by a video introducing the robot arm. ALS severity was ascertained using the extended ALS Functional rating Scale (ALSFRS-EX). RESULTS 268 ALS patients participated in the survey. The mean age at disease onset was 60 years (SD 10.6 years); 67 % (n=180) were male. The ALS severity score was 42.9 out of 60 on the ALSFRS-extended (SD 11.7 points), with the most relevant restrictions on arms and legs (less than 60 % of normal function). Technological readiness ranked high (top third with 47.2 out 0f 60 points). Younger patients (< 60 years; 50 vs. 46 points) and male (49.5 vs. 44 points) reached significantly higher values. The acceptance of robotic arm assistance (AMRAA) was again significantly higher in younger patients (25.5 vs. 16 points; p < .0001). However, the gender difference within the overall cohort was not significant (female/male: 18 vs. 22; p < .208). The acceptance measure was then correlated to the ALSFRS-EX subscale for arm functioning. The more limited the arm functioning, the higher the acceptance rate of robotic assistance. This relationship proved significant. CONCLUSIONS ALS patients display high technological commitment and feel positive about using technological assistance systems. Younger patients are more open towards technology use in general and robotic assistance in particular. Self-appraisal of technology acceptance, competence, and control conviction was 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. This is also reflected in users’ increased willingness to use a robotic arm as the functionality of their own arms decreased. Seen from the user perspective, there is currently a need for semi-automatic robotic arms in order to support caregivers and to allow patients to maintain their autonomy. These results form a basis on which robotic prototypes for nursing care can be designed. They also highlight the relevance of robotic assistance systems in promoting patient participation and autonomy in ALS assistive devices schemes.