Evaluating the Utilization and Efficiency of Wearable Exoskeletons for Spinal Cord Injury Rehabilitation

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The goal of this project is to acquire information that will guide evaluation strategies, training strategies, and clinical decision plans to enable the safe and effective use of robotic exoskeletons to enhance mobility in patients with Spinal Cord Injury.

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1. Describe the interest in, perceived need for, and expected outcomes of robotic exoskeletons of persons who have not received this therapy.
2. Describe the perceived benefits, limitations, and costs of robotic exoskeletons among persons with spinal cord injury who received this therapy during spinal cord injury rehabilitation or in the community, and compare their perspectives with persons who have no robotic exoskeleton experience.
3. Describe physical therapists’ experiences, clinical evaluation and training strategies using robotic exoskeleton therapy in rehabilitation and community settings.

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Approximately 130 participants will be recruited for an initial Environment Scan Survey. Those who indicate that we may contact for additional research will enter into a pool of participants from which 90-120 minute focus groups will be conducted with persons with SCI and rehabilitation professionals. Focus groups will take place across four sites: Shirley Ryan AbilityLab, Jesse Brown VA Medical Center, Shepherd Center, and Kessler Foundation. These focus groups will provide more information into patient and clinician experiences and opinions, identify perceived benefits and risks of exoskeleton use, and clinician and patient suggestions for changes to hardware and software.

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Feedback from persons with SCI is that exoskeletons must be less costly, provide more independence, and have a longer battery life before they would consider personally investing in a device. Users suggested features to improve accessibility and ease of use through greater adjustability, less obtrusive size, and capacity for transfers from wheelchair to robotic exoskeleton and in and out of cars.

Clinicians suggested numerous design features that would improve the usability of robotic exoskeletons including reducing weight, materials that reduce cost, components that are easy to replace, designs that allow easy donning and doffing, integrated electrical stimulation, more durable components, flexibility to fit various body types and self - balancing capabilities.

The results of this study provide guidance for robotic device manufactures, insurers, engineers and hospital administrators regarding the preferences from both persons with SCI and clinicians. 

Results that impact clinical practice are the identified benefits of exoskeleton use including decreased physical burden and fatigue on therapists while maximizing patient mobility, increased safety of clinicians and patients, and expanded device awareness and training.

For clinicians, the data show that robotic exoskeletons can reduce burden and fatigue by decreasing the amount of staff needed for gait therapy, while still providing quality patient mobility. Clinicians also identified increased safety for both themselves and patients, and discussed appropriateness of robotic exoskeletons for patients with particular characteristics, managing patient expectations, and identified improvements that manufacturers can utilize to design future devices. Most persons with SCI without experience were aware that robotic exoskeletons are available, but had mixed feelings about their practicality due to FDA-guidelines, cost, and benefits that could be gained. Persons with SCI with experience using the devices described ample psychological benefits gained from the exoskeleton providing eye-level contact, as well as endorsed physiological benefits such as improved bowel/bladder programs. Both those with experience and without agreed that robotic exoskeletons would be good therapy tools or beneficial for exercise, but that they must be less costly, provide more independence, and have a longer battery life before they would consider personally investing in a device.

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1. "Appraisals of Robotic Locomotor Exoskeletons for Gait: Focus Group Insights from Potential Users with Spinal Cord Injuries" publication in Disability and Rehabilitation: Assistive Technology.

• DOI: https://doi.org/10.1080/17483107.2020.1745910

2. "Clinician Perceptions of Robotic Exoskeletons for Locomotor Training Following Spinal Cord Injury: A Qualitative Approach" publication in Archives of Physical Medicine and Rehabilitation.

• DOI: https://doi.org/10.1016/j.apmr.2020.08.024

3. "Users with Spinal Cord Injury Experience of Robotic Locomotor Exoskeletons: A Qualitative Study of the Benefits, Limitations, and Recommendations” publication in Journal of NeuroEngineering and Rehabilitation.

• DOI: https://doi.org/10.1186/s12984-020-00752-9