# Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study

## TL;DR

A new digital gait training assistant for crutch use was developed and found to be more effective than traditional physiotherapy in teaching proper crutch techniques.

## Contribution

The study introduces and evaluates a novel gait training assistant that provides real-time feedback for crutch use during rehabilitation.

## Key findings

- Patients using the digital gait training assistant showed significantly better crutch angle and position compared to those trained by physiotherapists.
- Despite preferring in-person training, most patients found the digital system usable and enjoyable.
- The system was rated as above average in usability by the majority of participants.

## Abstract

Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary.

The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist.

As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke’s System Usability Scale score) and patient satisfaction.

All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean –6.3°, SD 3.5° vs mean –12.4°, SD 4.5°; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean –8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86%) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93%) and were interested in trying out other digital assistants (11/14, 79%). The usability of the GTA was rated above average by the majority (9/14, 64%) of the patients.

The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation.