Purpose: Wearable lower-limb robotic exoskeletons have emerged as promising tools for locomotor training in individuals with spinal cord injury (SCI). However, their bulky size, high cost, and limited usability hinder widespread acceptance. User-centered methods identifying end-users' unique insights are key to meet their specific challenges. This paper presents the co-creation methodology in developing the ABLE Exoskeleton, evolving from a knee-powered prototype (ABLEknee) to a hip-knee-powered exoskeleton (ABLEhipknee).
Methods: A 3-phase co-creation methodology is presented. Results from a pilot study with the ABLEhipknee over a 10-session training program on five non-ambulatory SCI participants and a comparative analysis with the ABLEknee are presented as evidence of the co-creation effectiveness. Trial Registration: NCT05590065.
Results: Improvements in walking time, steps, and distance, fewer device-related adverse events, lower assistance levels for therapy activities, 3-minute longer donning/doffing time with similar assistance levels, and higher user satisfaction scores for the ABLEhipknee compared to the ABLEknee were observed.
Conclusion: The ABLEhipknee is a safe, feasible tool for gait rehabilitation in SCI individuals in hospital settings, with better performance and higher user satisfaction than the ABLEknee. The pilot study highlights the positive impact of co-creation involving SCI individuals and therapists in developing rehabilitation technology. Further research is encouraged to validate these preliminary results.
Keywords: Co-creation; exoskeleton device; gait training; spinal cord injuries.
Engaging end-users and therapists in the development of rehabilitation technology throughout the iterative design process results in more clinically relevant design solutions.Usability testing of exoskeleton technology in the intended environment with the intended users is crucial throughout the development process, and not only in the evaluation phase.The co-creation process followed during the development of the ABLE Exoskeleton revealed that the key characteristics of an exoskeleton for the rehabilitation of people with spinal cord injury are versatility, trunk stability, and ease of use.