Acceptability of Overground Wearable Powered Exoskeletons for People with Spinal Cord Injury: A Multicenter Qualitative Study

Biomimetics, 2025 · DOI: https://doi.org/10.3390/biomimetics10010036 · Published: January 8, 2025

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study explores how well people with spinal cord injuries (SCI) accept and feel about using powered exoskeletons during rehabilitation. The researchers interviewed fourteen individuals with SCI who had used exoskeletons in Canada or France. The study found that most participants were motivated to use exoskeletons and saw benefits like improved walking patterns and increased endurance. However, they also experienced challenges such as pain, fatigue and the need for high concentration. Overall, the participants generally accepted the use of exoskeletons in their rehabilitation but suggested improvements like training in less cluttered environments and technological advancements to make the devices less heavy and restrictive.

Study Duration

Not specified

Participants

14 individuals with SCI (9 men, mean [SD] age 47 years [14.8], a majority with traumatic and thoracic lesion (T6–T12))

Evidence Level

Level 4, Qualitative Study

Key Findings

1
Participants were generally motivated and satisfied with using exoskeletons during rehabilitation, with many hoping it would help them walk again or improve their walking pattern.
2
Using an exoskeleton was physically and cognitively demanding, requiring high levels of concentration and physical effort, and some participants experienced minor pain or discomfort.
3
Few ethical considerations were discussed, but participants mentioned the risk of disappointment if expectations were not met and the importance of inclusive access to exoskeleton technology.

Research Summary

This qualitative study explored the acceptability of overground wearable powered exoskeletons among people with spinal cord injuries (SCI) in rehabilitation settings. The study found that participants generally had a positive attitude toward exoskeletons, were motivated to use them, and reported benefits such as improved walking patterns and increased endurance, despite the physical and cognitive demands. The findings suggest that exoskeletons are a promising rehabilitation technology, but improvements are needed, such as addressing the device's restrictive characteristics and increasing accessibility for a broader range of individuals with walking limitations.

Practical Implications

Refine Training Environments

Conduct training sessions in obstacle-free environments to enhance the effectiveness and safety of exoskeleton use.

Improve Device Design

Address restrictive characteristics, heaviness, and massiveness of exoskeletons through technological improvements.

Manage Expectations

Develop interventions to facilitate realistic expectations about the outcomes of exoskeleton use to avoid disappointment.

Study Limitations

1
The context of use in two different rehabilitation centers may influence the results obtained.
2
The time since the occurrence of the SCI was much shorter for people with SCIs using an exoskeleton at the CIUSSS-CN center than at the CMRRFK center. This may influence the perceived acceptability regardless of the exoskeleton per se.
3
CIUSSS-CN participants were invited to take part in interviews only if they completed the twelve-session training program of the research protocol.

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