Enhancing exoskeleton technology through co-creation with clinicians and patients: a pilot study and comparative analysis of the ABLE exoskeleton.

Abstract

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 (<i>ABLEknee</i>) to a hip-knee-powered exoskeleton (<i>ABLEhipknee</i>). A 3-phase co-creation methodology is presented. Results from a pilot study with the <i>ABLEhipknee</i> over a 10-session training program on five non-ambulatory SCI participants and a comparative analysis with the <i>ABLEknee</i> are presented as evidence of the co-creation effectiveness. Trial Registration: NCT05590065. 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 <i>ABLEhipknee</i> compared to the <i>ABLEknee</i> were observed. The <i>ABLEhipknee</i> is a safe, feasible tool for gait rehabilitation in SCI individuals in hospital settings, with better performance and higher user satisfaction than the <i>ABLEknee</i>. 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.