Appraisals of robotic locomotor exoskeletons for gait: focus group insights from potential users with spinal cord injuries

Abstract

Purpose: To describe appraisals of robotic exoskeletons for locomotion by potential users with spinal cord injuries, their perceptions of device benefits and limitations, and recommendations for manufacturers and therapists regarding device use.

Materials and methods: We conducted focus groups at three regional rehabilitation hospitals and used thematic analysis to define themes.

Results: Across four focus groups, 35 adults participated; they were predominantly middle-aged, male, and diverse in terms of race and ethnicity, well educated, and not working. Participants had been living with SCI an average of two decades. Most participants were aware of exoskeletons. Some were enthusiastic about the usability of the devices while others were more circumspect. They had many questions about device affordability and usability, and were discerning in their appraisal of benefits and suitability to their particular circumstances. They reflected on device cost, the need for caregiver assistance, use of hands, and environmental considerations. They weighed the functional benefits relative to the cost of preferred activities. Their recommendations focused on cost, battery life, and independent use.

Conclusions: Potential users’ appraisals of mobility technology reflect a nuanced appreciation of device costs; functional, social, and psychological benefits; and limitations. Results provide guidance to therapists and manufacturers regarding device use.

Implications for Rehabilitation

• Potential users of robotic locomotor exoskeletons with spinal cord injuries appreciate the functional, social, and psychological benefits that these devices may offer.

• Their appraisals reflect nuanced consideration of device cost and features, and the suitability of the assistive technology to their circumstances.

• They recommend that manufacturers focus on reducing cost, extending battery life, and features that allow independent use.

Keywords:

• Exoskeleton device
• spinal cord injury
• outcome
• rehabilitation
• focus groups
• assistive technology

Acknowledgments

The authors appreciate the contributions of the focus group participants who shared freely of their experience and perceptions, and the assistance of clinical and research staff at the collaborating sites who facilitated focus groups. Allison Peipert, Ontonio Jackson-Lucas, and Jamal Spraggins assisted with the project at the Shirley Ryan AbilityLab.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The U.S. Department of Defense’s Congressionally Directed Medical Rehabilitation Program funded ‘Evaluating the Utilization and Efficiency of Wearable Exoskeletons for SCI Rehabilitation’ (W81XWH-17-1-0157).