Perspectives of people with spinal cord injury learning to walk using a powered exoskeleton

Manns, Patricia J.; Hurd, Caitlin; Yang, Jaynie F.

doi:10.1186/s12984-019-0565-1

Cited by 38 publications

(69 citation statements)

References 39 publications

(51 reference statements)

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“…Based on the purpose and location of use, the potential of a wearable exoskeleton can be identified. The expected potential of an exoskeleton has previously been addressed in a qualitative study by Manns and colleagues 28 . They found that some participants expected the best potential for outdoor exoskeleton ambulation, whereas others expected better potential for functional indoor use during daily life activities (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…They found that some participants expected the best potential for outdoor exoskeleton ambulation, whereas others expected better potential for functional indoor use during daily life activities (e.g. cooking while standing) 28 . Yet, only when participants have an exoskeleton at their disposal in the home and community setting, the full potential of an exoskeleton can be truly assessed.…”

Section: Discussionmentioning

confidence: 99%

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Exoskeleton home and community use in people with complete spinal cord injury

Dijsseldonk

Nes

Geurts

et al. 2020

Sci Rep

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A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1–15]) out of 16 ([12–21]) days, in which participants took a median of 3,226 ([330–28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5–95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exoskeleton home and community use in people with complete spinal cord injury

Dijsseldonk

Nes

Geurts

et al. 2020

Sci Rep

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“…Although end-users' perspectives are essential in the design and development of assistive technology [12,13], there is a paucity of literature from both persons with disabilities and physiotherapists (PTs) perspectives [14,15]. Over the last decade end-user perspectives have primarily been studied in spinal cord injury (SCI) in which four studies used semi-structured interviews [16][17][18][19], and 3 studies used survey methods [20][21][22] with sample size ranging from 3 to 20 persons. However, these studies included both complete and incomplete SCI with most participants being non-ambulatory representing a very different end-user population compared to persons post-stroke.…”

Section: Introductionmentioning

confidence: 99%

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

Vaughan-Graham

Brooks

Rose

et al. 2020

J NeuroEngineering Rehabil

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Background Wearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton. Methods We used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton. Results Five persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use. Conclusions This study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.

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“…Regarding actuation, the most frequent actuators are electric motors, probably due to the fact that they are easy to control and exhibit great precision with high specific power . In fact, in the study by Manns et al [68] nine out of eleven participants said that they would be willing to take the exoskeleton home if the cost of the device was not a factor.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, in order to avoid falls and provide balance, individuals need supportive devices such as crutches, walkers and canes ( Figure 5B), which can limit the independence and mobility of the user, and may lead to shoulder pain [67]. In the study by Manns et al [68], which evaluated the perspective of the participants after training with the ReWalk exoskeleton, several participants emphasized the effort exerted with the arms while using the exoskeleton. From this review, we found that patients with SCI commonly ended up using a walker or crutches whereas post-stroke patients, due to their hemiparesis, used a cane on the unaffected side.…”

Section: Design and Structurementioning

confidence: 99%

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

Rodríguez-Fernández

Lobo-Prat²,

Font-Llagunes

2020

Preprint

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Abstract Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what are the benefits and risks for exoskeleton users?, and (3) what is the current evidence on clinical efficacy for wearable exoskeletons?. We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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Perspectives of people with spinal cord injury learning to walk using a powered exoskeleton

Cited by 38 publications

References 39 publications

Exoskeleton home and community use in people with complete spinal cord injury

Exoskeleton home and community use in people with complete spinal cord injury

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

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