Needs and wishes for the future lower limb exoskeleton: an interview study among people with spinal cord injury with community-based exoskeleton experience

Figures & data

Table 1. Characteristics of people with community-based exoskeleton experience who participated in the study.

	Total (N = 13)
Sex (male/female)	7/6
Age (years), median [min–max]	33 [25–52]
Time post-injury (years), median [min–max]	8 [2–28]
Neurological level of SCI (thoracic), median [min–max]	Th9 [Th4–L1]
Classification of SCI level (low (Th7–L1)/high (Th1–6))	7/6
AIS (A/B)	12/1
Purchased own exoskeleton (yes*/no)	3/10
Exoskeleton experience (ReWalk™ in community setting/Indego^® in clinical setting/other exoskeleton (i.e., March/Symbitron) in lab setting)	13/4/4
Time since last community-based exoskeleton use and the interview (years), median [min–max]	2 [0–4]

AIS: American Spinal Injury Association Impairment Scale; Th: Thoracic; L: Lumbar. *Purchased through crowd funding.

Table 2. Purpose of exoskeleton use with exemplary citations.

Daily activities
“As it is now, I would use the Rewalk for what I call physio sports. However, you would want to use it to do the things you used to be able to do, like getting up, driving a car, you’d put it on in the morning and keep it on all day. Possibly using it in combination with a wheelchair. It’d be nice though if you didn’t need your wheelchair at all.” P10^female_highSCI
“Well, what I envision is a kind of exoskeleton that I can put on like a pair of trousers and that I can wear sitting in my wheelchair. So that, whenever I want to, I can get up or climb a flight of stairs, or whatever. […] When I think of that, of what would be possible, a whole new world opens up.” P11^male_lowSCI
“Everything. Daily life in its entirety. It should just replace your legs, period. In the supermarket, you grab a cart, put [the groceries] from the shelf into the cart. Practicalities.” P12^male_lowSCI
“Yeah look the thing you would obviously prefer is not to have to use your wheelchair. So if I would indicate that it is just something that you put on like a pair of pants or a suite or something like that, then you just walk away and you don't notice that you have a handicap. I don't think that's realistic.” P2^female_lowSCI
Exercise
“The purpose of walking? Well, for me it’s pushing back the boundaries. Each time, I try to walk further with it. That’s great. First just a short distance, and then each time go a bit farther. Yeah, the goal is to push back the boundaries and see how far you can walk with a suit [=exoskeleton] like this.” P9^male_lowSCI
“But I’d like to use it in a rehabilitation centre, for example, to be able to walk. Preferably together with others, so you can learn from each other. For the health benefits, you know. I wouldn’t use it so much for practical things, but more to improve my health, and not have to sit in my chair all day. That I can walk. That there’s pressure on my joints. So that you can keep walking. That’s why I think it’s useful… to improve your health. I’d really like to use it for that.” P2^female_lowSCI
“Also for health reasons, of course. Having walked for about three and a half months I felt even fitter. Just bladder and bowel goes easier and, when you walk and move your hips a few times a week, it [your body] feels more comfortable, that sounds a bit weird, but yes that's what happens." P4^female_highSCI
Social interaction
” So that you can join in. For instance, I hate parties where they have standing tables. It’d be great to be able to just stand at a table like that. And with a bar stool nearby for support if necessary or to rest a bit, so that basically you don’t stand out from the crowd. Yes, I think that’s something that would make this kind of suit [=exoskeleton] very useful.” P7^female_highSCI
^“I didn’t want to think about that for a very long time. I told myself that it wasn’t really important to me. But it’s true that people really like to look at you at eye level. And they suddenly notice you again and say, hey, wow, I haven’t seen you standing up like this before.” P5^female_lowSCI
”Ultimately, I’d like to be able to, for example, go for a walk on the beach with my daughters, or take them to an amusement park, and go on rides you actually have to go up steps for. Or at least that you can do things that you can't do right now because of that [wheel]chair.” P3^male_lowSCI

Figure 1. Inductive themes for exoskeleton improvements that could optimize the future exoskeleton according to people with a complete spinal cord injury with community-based exoskeleton experience. The inner circles of improvement are less purpose- and person-dependent than the outer circles. This means that the innermost circle was relevant for many purposes of use and supported by many participants (i.e., mentioned by all participants in a similar fashion). The circles closer to the edge represent improvements that are more dependent on the purpose of use (i.e., relevant for less purposes) and/or more person-dependent (i.e., mentioned by only a few participants with more diverse opinions).

A round shape consisting of four circles inside each other from large to small. In the center is the text “Future exoskeleton.” Within each circle is text describing the inductive themes for exoskeleton improvements. Ordered from inner to outer circle the text is: (1) “Easy to use,” (2) “Small, lightweight, and tailor made,” (3) “Safe, comfortable, and less distinctive,” and (4) “Affordable and durable”.