Category: Spinal Cord Injury; Technology (e.g. robotics, assistive technology, mHealth)
Objective : To identify patients’ priorities for use of wearable robotic exoskeletons (WRE) after spinal cord injury (SCI)
Qualitative case series
Setting : Clinic, home, and community
Participants (or Animals, Specimens, Cadavers) : 16 SCI patients; 4 clinicians
Interventions : Not applicable
Main Outcome Measure(s) :
We conducted 20 (16 initial, 49-98 minutes; 4 follow-up, 32-161 minutes) semi-structured interviews to identify themes surrounding use of the three, principal, FDA-approved WRE: the EksoGT, Indego, and ReWalk. Key informant, 60-minute, background interviews were also conducted with a clinical psychologist, occupational therapist, and a WRE industry representative. Interviews were guided by the Framework of Usability for Robotic Exoskeletal Orthoses (FUREO), transcribed and analyzed according to Interpretative Phenomenological Analysis methods using NVivo12 software.
Results : Participants differentiated the phenomenon of walking from the more global concept of mobility. WRE were viewed as an adjunct to wheelchair mobility, not a replacement. Consumers perceived WRE as facilitators of walking specifically, which all valued for exercise and perceived positive impact on physical health. Though the majority also perceived emotional and social benefits to WRE-facilitated walking, a minority believed focus on walking put individuals at risk for failure to adjust and thrive after injury. WRE priorities diverged by individuals’ goals for use. For example, device factors such as ease of operation and safety were strong concerns of consumers desiring to use WRE in the community but by those whose intent was clinical use. Cost was the greatest perceived barrier to increased WRE utilization across all use cases.
Conclusions : WRE priorities differed by patient goals for use and environment, clinic or community. WRE decision making should be grounded in specific applications for use.
Manon Schladen– Senior Research Associate, MedStar Health Research Institute, Annapolis, Maryland
Suzanne Groah– Director of Spinal Cord Injury Consultation Liaison Service and of Spinal Cord Injury Research at MedStar National Rehabilitation Network and Associate Professor of Rehabilitation Medicine, NRH/Georgetown, Washington, District of Columbia
Alexander Libin– Associate Professor, Geoergetown University Medical Center, Washington, District of Columbia
Peter Lum– Professor & Chair, Department of Biomedical Engineering, The Catholic University of America, Washington, District of Columbia
Rochelle Tractenberg– Professor, Georgetown University, Washington, District of Columbia