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  • Deborah Hill (a1), Catherine Sarah Holloway (a2), Dafne Zuleima Morgado Ramirez (a2), Peter Smitham (a3) and Yannis Pappas (a4)...


Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology.

Methods: A systematic literature search was conducted across several healthcare related online databases.

Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users’ expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training.

Conclusions: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users’ perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable.



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1. Cenciarini, M, Dollar, AM, editors. Biomechanical considerations in the design of lower limb exoskeletons. IEEE Int Conf Rehabil Robot. 2011;2011:5975366.
2. Mertz, L. The next generation of exoskeletons: Lighter, cheaper devices are in the works. IEEE Pulse. 2012;3:5661.
3. Ekso, Bionics. [Internet]. Ekso Bionics - Exoskeleton, wearable robot for people with paralysis from spinal cord injury or stroke. (accessed June 3, 2015).
4. Rex, Bionics. [Internet]. Rex Bionics: Our products. (accessed June 3, 2015).
5. ReWalk, Robotics. [Internet]. ReWalk: More Than walking 2016. (accessed April 26, 2016).
6. Parker Hannifin Corp. [Internet]. Indego: Powering people forward 2016. (accessed April 26, 2016).
7. Gwynne, P. Technology: Mobility machines. Nature. 2013;503: S16-SS7.
8. Woollaston, V. [Internet]. Robotic exoskeleton to help rehabilitate disabled people passes safety tests - paving the way for it to go on sale in the UK. 2013.–paving-way-sale-UK.html (accessed June 3, 2015).
9. Buckland, D, Low, V. [Internet]. Robotic wedding suit lets father of bride make moving speech The Times. 2014. (accessed June 3, 2015).
10. Nicholson, R. [Internet]. Opinion: Why the obsession with walking? 2013. (accessed June 3, 2015).
11. Bohannon, R. Comfortable and maximal walking speeds of adults aged 20–79 years: Reference values and determinants. Age Ageing. 1997;26:1519.
12. Esquenazi, A, Talaty, M, Packel, A, Saulino, M. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. 2012;91:911921.
13. Karmarkar, AM, Cooper, RA, Wang, H, Kelleher, A, Cooper, R. Analyzing wheelchair mobility patterns of community-dwelling older adults. J Rehabil Res Dev. 2011;48:10771086.
14. Cowan, RE, Fregly, BJ, Boninger, ML, Chan, L, Rodgers, MM, Reinkensmeyer, DJ. Recent trends in assistive technology for mobility. J Neuroeng Rehabil. 2012;9:20.
15. Tobe, F. [Internet]. 3 Exoskeleton companies go public the robot report. 2014. (accessed June 3, 2015).
16. Demain, S, Burridge, J, Ellis-Hill, C, et al. Assistive technologies after stroke: Self-management or fending for yourself? A focus group study. BMC Health Serv Res. 2013;13:334.
17. McMillen, A-M, Söderberg, S. Disabled persons’ experience of dependence on assistive devices. Scand J Occup Ther. 2002;9: 176183.
18. Brown-Triolo, DL, Roach, MJ, Nelson, K, Triolo, RJ. Consumer perspectives on mobility: Implications for neuroprosthesis design. J Rehabil Res Dev. 2002;39:659670.
19. Miller, LE, Zimmermann, AK, Herbert, WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: Systematic review with meta-analysis. Med Devices (Auckl). 2016;9:455466.
20. Bortole, M, Venkatakrishnan, A, Zhu, F, et al. The H2 robotic exoskeleton for gait rehabilitation after stroke: Early findings from a clinical study. J Neuroeng Rehabil. 2015;12:54.
21. Benson, I, Hart, K, Tussler, D, van Middendorp, JJ. Lower-limb exoskeletons for individuals with chronic spinal cord injury: Findings from a feasibility study. Clin Rehabil. 2016;30: 7384.
22. Wolff, J, Parker, C, Borisoff, J, Mortenson, WB, Mattie, J. A survey of stakeholder perspectives on exoskeleton technology. J Neuroeng Rehabil. 2014;11:169.
23. Rosati, G, Oscari, F, Reinkensmeyer, DJ, et al. Improving robotics for neurorehabilitation: Enhancing engagement, performance, and learning with auditory feedback. IEEE Int Conf Rehabil Robot. 2011;2011:5975373.
24. Zeilig, G, Weingarden, H, Zwecker, M, Dudkiewicz, I, Bloch, A, Esquenazi, A. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study. J Spinal Cord Med. 2012;35:96101.
25. Giszter, SF. Spinal cord injury: Present and future therapeutic devices and prostheses. Neurotherapeutics. 2008;5:147162.
26. Shah, SGS, Robinson, I. Benefits of and barriers to involving users in medical device technology development and evaluation. Int J Technol Assess Health Care. 2007;23:131137.
27. Lane, JP, Usiak, DJ, Stone, VI, Scherer, MJ. The voice of the customer: Consumers define the ideal battery charger. Assist Technol. 1997;9:130139.
28. ATIA. [Internet]. ASSISTIVE TECHNOLOGY: What is it? What do you need to know? (accessed January 14, 2016).
29. Biddiss, E, Chau, T. Upper-limb prosthetics: Critical factors in device abandonment. Am J Phys Med Rehabil. 2007;86: 977987.
30. Kittel, A, Marco, AD, Stewart, H. Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury. Disabil Rehabil. 2002;24:106114.
31. Kiesler, S, Hinds, P. Human-robot interaction: Citeseer. Hum-Comput Interact. 2004;19:18.
32. Pape, TL-B, Kim, J, Weiner, B. The shaping of individual meanings assigned to assistive technology: A review of personal factors. Disabil Rehabil. 2002;24:520.
33. Bates, PS, Spencer, JC, Young, ME, Rintala, DH. Assistive technology and the newly disabled adult: Adaptation to wheelchair use. Am J Occup Ther. 1993;47:10141021.
34. Shah, SGS, Robinson, I, Alshawi, S. Developing medical device technologies from users' perspectives: A theoretical framework for involving users in the development process. Int J Technol Assess Health Care. 2009;25:514521.
35. Martin, JL, Murphy, E, Crowe, JA, Norris, BJ. Capturing user requirements in medical device development: The role of ergonomics. Physiol Meas. 2006;27:R49.
36. Kilgore, KL, Scherer, M, Bobblitt, R, et al. Neuroprosthesis consumers' forum: Consumer priorities for research directions. J Rehabil Res Dev. 2001;38:655660.
37. Daily Mail Reporter. [Internet]. Revolutionary exoskeleton that helps wheel-chair bound walk to go on sale in UK. 2011. (accessed April 26, 2016).
38. Pons, JL. Rehabilitation exoskeletal robotics. IEEE Eng Med Biol Mag. 2010;29:5763.



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