User satisfaction with lower limb wearable robotic exoskeletons

Abstract

Objective: To provide the results of a robotic exoskeleton user satisfaction questionnaire completed by participants utilizing two robotic exoskeletons.

Method: Seven individuals with physical disabilities engaged in two exoskeleton-assisted training phases with the REX and the Ekso 1.1 (Ekso), after which they completed a user satisfaction questionnaire. The questionnaire consisted of structured items with a Likert scale, which were averaged and compared, as well as free response questions, which were interpreted thematically.

Results: Participants reported some differences in user satisfaction between the two exoskeletons. They indicated higher satisfaction with transferring in and out of the REX and with its appearance and higher satisfaction with the transportability of the Ekso. Expectations for exoskeleton use were relatively similar for the two devices, with some exceptions. Whereas participants indicated that many changes should be made to both exoskeletons, they reported that some were more necessary for the REX and others were more necessary for the Ekso. Participants reported that they would be somewhat likely to use both exoskeletons at home and in the community if they were available.

Conclusions: This brief report provides an initial comparison of user satisfaction with two exoskeletons, thereby contributing to the growing body of literature in this area.

• Implications for rehabiliation

• Contributes to the literature on user satisfaction with robotic exoskeletons Implications for rehabilitation

• Emphasizes the role of user/participant/patient feedback in rehabilitation research

• Provides user satisfaction questionnaire items that can be used in future studies

     

Robotic exoskeletons for reengaging in everyday activities: promises,pitfalls, and opportunities

Abstract

Purpose: Media images and marketing materials suggest a future in which individuals with spinal cord injury (SCI) can utilize robotic exoskeletons to reengage in everyday activities, yet these narratives may not align with the current technological realities. The purpose of this paper is to present and describe the current use of robotic exoskeletons in rehabilitation and home settings and discuss the benefits and limitations of the devices.

Materials and methods: We provide an overview of the features and limitations of the four robotic exoskeleton products (EKSO Bionics, ReWalk, Rex Bionics, and Indego) that are currently being used in in the United States in rehabilitation settings. We follow by suggesting ways that these devices fall short of fulfilling the promise of reengage in everyday activities in real-world life contexts.

Results and discussion: Available devices appear to be better suited for rehabilitation settings than for home use. Device weight, the need for upper extremity supports, supervision requirements, and a limited range of movements are all issues that limit functionality and restrict opportunities for using such devices in real-world contexts. Designing the next generation of exoskeletons to be more useful in everyday life will require further collaboration among engineers, clinicians, and patients.

• Implications for Rehabilitation

• Exoskeletons offer the promise of allowing individuals with neurological injury to reengage in everyday activities from a standing position.

• Several exoskeleton devices are currently available for use in the United States.

• Weight of exoskeleton devices, the need for upper extremity supports, supervision requirements of hone units, and a limited range of movements are issues that restrict opportunities for using such devices in real-world contexts.

• Further development of exoskeleton technologies is warranted to improve the devices for real-world use.

     

Development of an unpowered ankle exoskeleton for walking assist

Abstract

Aim: Assistive technologies traditionally rely on either powered actuation or passive structures to provide increased strength, support or the ability to perform specific functions. At one end of the spectrum are powered exoskeletons, which significantly increase a user’s strength, but require powerful actuators, complex control systems and heavy power sources. At the other end are orthoses, which are generally unpowered and light in weight, relying on the mechanical properties of passive mechanical elements. Ideally, assistive technologies should combine the benefits of both systems and enhance human motion while remaining lightweight and efficient. This paper presents the development of a lightweight unpowered ankle exoskeleton that relies on the spring-like properties of a Pneumatic Artificial Muscle, which is inflated and sealed.

Methods: This flexible air-spring is used to harness gait energy and compliment the human ankle torque at push-off. To mechanically validate the proposed exoskeleton design, a prototype was fabricated and experimentally tested.

Results: Unlike other existing devices, the proposed unpowered exoskeleton was able to store a significant amount of energy and release it all at once. The timing mechanism worked as intended and triggered the release of 115?N?m of torque when the ankle reached a pre-determined angle.

Conclusion: Overall, the device demonstrated the ability to provide significant contribution to the ankle torque, timed to release precisely at the push-off phase of the gait cycle.

• Implications for Rehabilitation

• The currently proposed ankle exoskeleton makes use of an unpowered, fully mechanical system to provide walking assistance to users by providing additional torque to the ankle joint.

• The newly developed assistive device is devised as a solution for persons struggling with mobility issues, and can be used both as a means for rehabilitation or as a permanent assistive devices for patients struggling with long-term disabilities.

• The device also has potential to be used as a performance enhancing device for ablebodied users by reducing muscle fatigue during extended physical exertion.

     

An exploration of the experiences of Brazilian hemiplegic manual wheelchair users

Abstract

Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs.

Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users.

Results: The results identified 4?key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision.

Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment.

• Implication for rehabilitation

• Adding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment.

• The importance of involving the user in decisions made about wheelchair provision.

• Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.

     

Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs

Abstract

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs’ performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.

• Implications for rehabilitation

• Carbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these models

• Carbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, however

• Increased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their community

• The low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment

     

Feasibility of integrating robotic exoskeleton gait training in inpatient rehabilitation

Abstract

Objective: Learning to walk is a major goal of inpatient rehabilitation and robotic exoskeletons may provide a new gait training approach. Our purpose was to determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population.

Design: Longitudinal cohort design and convenience sample including physical therapists trained to use the Ekso Bionics Ekso GT? robotic exoskeleton or inpatients with stroke or SCI. Therapists completed a focus group and survey at baseline and 6 months after initial Ekso training. Patients completed a survey indicating their satisfaction with using the Ekso.

Results: Twenty-five patients used the Ekso an average of 4.5 sessions during their 38.5-day rehabilitation stay. Survey and focus group feedback revealed that therapists encountered measurement difficulties with the Ekso and limited treatment time influencing effectiveness of usage. After 6 months, therapists reported an improvement in feasibility. Patients tolerated Ekso sessions well, without any complications or adverse incidents, and reported improved mobility post session.

Conclusion: Integrating Ekso gait training into clinical practice was not seamless but appears feasible. Barriers were addressed within the rehabilitation team and received administrative support in a process lasting several months. Patients enjoyed walking in Ekso and felt secure within the device.

• Implications for rehabilitation

• Integrating Ekso gait training into clinical practice during inpatient rehabilitation is feasible.

• Overcoming barriers to implementation required administrative support and clinician persistence over several months.

• Patients tolerated Ekso sessions well, without any complications or adverse incidents.

     

A survey on what Australians with upper limb difference want in a prosthesis: justification for using soft robotics and additive manufacturing for customized prosthetic hands

Abstract

Purpose: Upper limb prostheses are part of a rapidly changing market place. Despite development in device design, surveys report low levels of uptake and dissatisfaction with current prosthetic design. In this study, we present the results of a survey conducted with people with upper limb difference in Australia on their use of current prostheses and preferences in a prosthetic in order to inform future prosthetic hand design.

Methods: An online survey was conducted on upper limb amputees, with 27 respondents that completed the survey. The survey was a mixture of open-ended questions, ranking design features and quantitative questions on problems experienced and desired attributes of future prosthesis designs.

Results: Common key issues and concerns were isolated in the survey related to the weight, manipulation and dexterity, aesthetics, sensory feedback and financial cost; each of which could be addressed by additive manufacturing and soft robotics techniques.

Conclusions: The adaptability of additive manufacturing and soft robotics to the highlighted concerns of participants shows that further research into these techniques is a feasible method to improve patient satisfaction and acceptance in prosthetic hands.

• Implications for rehabilitation

• Even with recent developments and advances in prosthetic design, the needs and desires of prosthetic users are not being met with current products.

• The desires and needs of those with upper limb difference are diverse.

• Using additive manufacturing to produce prosthetics allows for mass customization of prosthetics to meet these diverse needs while reducing costs.

• A soft robotic approach to prosthetics can help meet the desires of reducing weight and costs, while maintaining functionality.

     

Effectiveness and usability of Scanning Wizard software: a tool for enhancing switch scanning

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study evaluated Scanning Wizard’s effectiveness and usability. Ten people who use switch scanning and ten practitioners used Scanning Wizard in the initial session. Usability was high, based on survey responses averaging over 4.5 out of 5, and qualitative feedback was very positive. Five switch users were able to complete the multi-week protocol, using settings on their own scanning system that were recommended from the Scanning Wizard session. Using these revised settings, text entry rates improved by an average of 71%, ranging from 29% to 172% improvement. Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

• Implications for Rehabilitation

• Some individuals with severe physical impairments use switch scanning for spoken and written communication.

• Scanning Wizard software helps scanning users improve the setup of their switch and scanning system.

• This study demonstrated high usability of Scanning Wizard (with 10 switch userpractitioner teams) and increased text entry rate by an average of 71% (for five switch users).

• Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

     

Prevalence of falls in frail elderly users of ambulatory assistive devices: a comparative study

Abstract

Aim: The aim of this study was to verify the prevalence of falls in frail users of ambulatory assistive devices (AAD) and compare with controls.

Materials and methods: Nineteen frail elderly users of AAD (G1) and 31 non-users (G2) participated in the study. The occurrence of falls, at the last 6 months, was collected by an interview with the patient and the caregiver. Cognitive status was assessed by the Mini Mental State Examination, functional capacity by the Pfeffer’s Questionnaire and Modified Barthel’s Index, the frail level by a functional stratification and the risk of falls by the Timed Up and Go (TUG) test. T-Student test was used to compare independent variables. The significance level was set at 5%.

Results: Both groups G1 and G2 were homogeneous in relation to the functional and sociodemographic variables. G1 reported more falls in the last 6 months, but most of the participants did not use AAD at the time of the fall. Transferences were the main reason for falls in G1 and stumble in the street in G2.

Conclusion: Elderly users of AAD fall out when they are not using the walk device.

• IMPLICATIONS FOR REHABILITATION

• Falling is the second leading cause of death from unintentional injuries in the world. Fall prevention programmes prescribe ambulatory assistive devices, such as walking sticks, crutches and walkers device and walking training with a physiotherapist to provide independence, safety, satisfaction, adherence and psychosocial benefits. However, studies have showed a higher prevalence of falls in frail elderly users of ambulatory-assistive devices.

• In our study, we verified if users of the ambulatory-assistive devices were using it at the moment of the fall. We found that frail elderly fall down when they are not using the walk device during their activities of day living. Thus, education strategies should be developed to encourage the use of ambulatory-assistive devices by the frail elderly previously evaluated by physiotherapists. Prevalence of falls in this population could reduce if frail elderly users of ambulatory assistive devices really use it during the activities of daily living.

     

An exploration of usability issues in telecare monitoring systems and possible solutions: a systematic literature review

Abstract

Background: The idea of product usability has been discussed in several research areas including product research and development. Usability, in telecare monitoring systems, determines how much the system is effective and efficient for the telecare users. Usability has been considered an important factor in the acceptance of telecare monitoring systems by individuals who encounter challenges in the use of such systems and who possess a limited knowledge of their use.

Objectives: The purpose of this study is to explore the relevant usability issues and identify possible solutions to improve the usability of telecare monitoring systems.

Method: The study is based on eight research questions and to find the answers to those research questions, a systematic literature is performed.

Results: The research findings highlight various usability issues, including the complexity of the interface, difficulty in reading the text, and insufficient provision of instructions. These studies have also suggested solutions to enhance the usability of systems, including development of the technical skills of users, explanations of usability evaluation techniques for telecare monitoring systems, and engaging the appropriate users during the development of telecare monitoring systems.

• Implications for rehabilitation

• Successful implementation of telecare monitoring systems can increase the chances of acceptance of telecare monitoring systems by the users.

• Implementing an efficient and effective system will make telecare users more independent at their homes.

• The development of usable telecare monitoring systems can significantly contribute to a basis for clinical and home-based implementation of the telehealth technology to promote remote monitoring for elderly and people with disabilities.

• Considering the usability issues and solutions identified in this study, it will go a long way towards aiding subsequent researchers and developers in the implementation of more usable and valid telecare monitoring systems.

     

Self-reported difficulty and preferences of wheeled mobility device users for simulated low-floor bus boarding,interior circulation and disembarking

Background: Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly accommodating or challenging. The objective of this study was to determine the effects of low-floor bus interior seating configuration and passenger load on wheeled mobility device user-reported difficulty, overall acceptability and design preference.

Methods: Forty-eight wheeled mobility users evaluated three interior design layouts at two levels of passenger load (high vs. low) after simulating boarding and disembarking tasks on a static full-scale low-floor bus mockup.

Results: User self-reports of task difficulty, acceptability and design preference were analyzed across the different test conditions. Ramp ascent was the most difficult task for manual wheelchair users relative to other tasks. The most difficult tasks for users of power wheelchairs and scooters were related to interior circulation, including moving to the securement area, entry and positioning in the securement area and exiting the securement area. Boarding and disembarking at the rear doorway was significantly more acceptable and preferred compared to the layouts with front doorways.

Conclusion: Understanding transit usability barriers, perceptions and preferences among wheeled mobility users is an important consideration for clinicians who recommend mobility-related device interventions to those who use public transportation.

• Implications for Rehabilitation

• In order to maximize community participation opportunities for wheeled mobility users, clinicians should consider potential public transit barriers during the processes of wheelchair device selection and skills training.

• Usability barriers experienced by wheeled mobility device users on transit vehicles differ by mobility device type and vehicle configurations.

• Full-scale environment simulations are an effective means of identifying usability barriers and design needs in people with mobility impairments and may provide an alternative model for determining readiness for using fixed route buses or eligibility for paratransit.

     

The influence of operator and wheelchair factors on wheelchair propulsion effort

Abstract

Purpose: The goal of this study was to evaluate the relative influence of operator and wheelchair factors on propulsion effort during over-ground wheelchair manoeuvres.

Method: This observational study included 23 full-time manual wheelchair users and 13 able-bodied subjects. The operator factors included shoulder position, aerobic capacity and propulsion strength. The wheelchair factors included system mass, weight distribution, and frictional loss in straight and turning trajectories. The performance of over-ground manoeuvres was defined as the propulsion effort measured by VO₂ as operators propelled along a modified figure-8 course on tile and carpet surfaces.

Results: According to our regression model, shoulder position was the only significant contributor within operator factors, whereas weight distribution was the only significant contributor within wheelchair factors in influencing propulsion efforts. When combining operator and mechanical factors in the regression model, weight distribution became the only significant contributor to influence propulsion effort.

Conclusion: Weight distribution and shoulder position had a significant influence on propulsion effort. These variables are related to the operator’s relationship to the drive wheels. However, system mass and muscle strength had the least influence on wheelchair manoeuvres. Our finding can help clinicians to improve wheelchair configurations and manufacturers to improve wheelchair design by understanding the importance of shoulder position and weight distribution.

• Implication for rehabilitation

• Studying wheelchair manoeuvers by considering both wheelchair and operator factors might provide a unique insight to address the complex interactions among wheelchair designs and users.

• Propulsion effort decreases as percentage weight is increased on the drive wheels and the shoulder becomes more aligned with the axle position, which highlights the need to optimize wheelchair axle position.

• Wheelchair configuration, as represented by weight distribution, had a more significant influence on everyday manoeuvre than wheelchair mass does.

• It is essential for wheelchair users to choose a wheelchair that can match their daily needs and anthropometric measurements for saving propulsion efforts.

     

Comparison of seating,powered characteristics and functions and costs of electrically powered wheelchairs in a general population of users

Purpose: To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs.

Method: Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded.

Results: 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3–4 times stroke users.

Conclusions: This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning.

• Implications for Rehabilitation

• At a service planning level, knowledge of a population’s diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs.

• At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users’ needs within diagnostic groups.

• The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision.

     

Lessons from Vienna: stakeholder perceptions of functional electrical stimulation technology and a conceptual model for practice

Abstract

Aim: Functional electrical stimulation (FES) is a technology that can be used on paralyzed muscles to allow them to move. It has been used in populations with muscle paralysis or weakness for exercise, such as spinal cord injury (SCI) and multiple sclerosis. In order to improve technology, it is vital to understand from a qualitative perspective, issues surrounding device development and implementation.

Materials and Methods: In 2016, a study was conducted at the Medical University of Vienna that sought to unravel perspectives of FES exercise from the perspective of clinicians, engineers and researchers. Semi-structured, qualitative interviews were conducted on a sample of participants from the conference (n?=?22). Interviews were transcribed verbatim, and text data were analysed.

Results: Following this analysis, a conceptual model of FES application in the home environment was derived. We show that the likelihood of continuing FES over time may be influenced by expectations and initial education, as perceived by stakeholders.

Conclusion: This model provides a tool by which researchers or clinicians may implement FES in the home environment and may assist in the increased uptake of FES exercise at home for people who may reap benefits from its use.

• Implications for Rehabilitation

• Functional electrical stimulation (FES) is a technology that enables individuals with paralysis, such as Spinal Cord Injury or Multiple Sclerosis, to exercise.

• Motivation and support networks, along with adequate initial education, are essential should patients be able to successfully use FES for exercise.

• There are unique issues associated with performing FES in the home, and compliance may be influenced by how patients perceive FES with regard to providing benefits, and what their initial expectations are.

• Communication and education are essential for all parties involved in the provision of FES treatment, to ensure successful treatment with FES at home.

     

Methodology and feasibility of a 3D printed assistive technology intervention

Abstract

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team’s ability to manage and implement the study, and the participant’s preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team’s ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted.

• IMPLICATIONS FOR REHABILITATION

• 3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technology

• Evaluation for assistive technology that will be 3D printed should include information about the person’s activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure.

• 3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training.

• Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors.

     

Design of a modular wheelchair with posture transformation capabilities from sitting to standing

Abstract

A significant part of world’s population is handicap, with majority suffering from lower body disabilities – the body waist down is paralysed or weak. In many of such cases, upper body of the affected person was found to be deemed fit and was able to perform all tasks, if feasible. Being able to transform posture from sitting to standing position independently, helps perform routine jobs with ease, increases employment prospects and improves blood circulation to name a few. Most of the existing wheelchair designs are expensive because of the electrical and electronics involved requiring added maintenance, or contain a variety of subsystems thus decreasing reliability. The objective is to further increase the posture transformation capabilities in terms of cost, user effort, maintenance and life. The modular wheelchair allows the user to use his/her own energy and bodyweight to shift from sitting to standing position and back, in single smooth movement with zero dependency on electrical/electronic parts. Detailed design of links, mechanisms and load calculations were performed as per standard requirements. Prototype of the proposed design was also made and successfully tested for all its design features and capabilities as per the design standards and conditions of physically challenged people.

• Implications for rehabilitation

• Five bar link mechanism helps to reduce manual effort.

• There is no dependency on auxiliary power source.

• It is a low cost rehabilitation solution with increased posture transformation capabilities.

• Increased body movements will help to increase self-confidence of disabled person.

• Easy sitting and standing capabilities will improve overall bodily functions and remove psychological barriers.

     

A review of gait disorders in the elderly and neurological patients for robot-assisted training

Abstract

Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users.

Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted.

Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients.

Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices.

• Implications for rehabilitation

• The support requirements provide the foundation for designing assistive devices.

• The findings will be crucial in defining the design criteria for robot assistive devices.

     

Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton

Aim: The main objectives of this study were to quantify clients’ satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton.

Methods: A group of 14 wheelchair users with a spinal cord injury, who finished a 6–8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from “0?=?totally disagree” to “100?=?completely agree”.

Results: Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7?±?0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3?±?6.9%), the attributes of the locomotor training program (84.5?±?6.9%) and their ability to learn to perform sit–stand transfers and walk with the robotic exoskeleton (79.6?±?17%). Respondents perceived some health benefits (67.9?±?16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7?±?8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3?±?0.1%).

Conclusion: This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials.

• Implications for Rehabilitation

• All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6–8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit–stand transfers and walk with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6–8-week locomotor training program with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise.

• Additional research on clients’ perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.