Perceived Value, Ownership, and Barriers to Smart Home Technology for Individuals with Spinal Cord Injury and Disease.

Abstract

To investigate the categories of Mainstream Smart Home technology (MSHT) that are commonly owned by individuals with spinal cord injury and disease (SCI/D), their perceived benefits, and barriers to obtaining or utilizing. Cross-sectional. SCI Model Systems. Individuals (N=417) 18 years of age or older enrolled in a participating SCI Model Systems Center between October 2022 and May 2025. Not applicable. Participants were surveyed on 18 categories of MSHT and indicated for each ownership status, perceived benefit of owning (yes, no, unsure), acquisition method, satisfaction, and barriers to ownership or use. The median number of MSHT categories owned per participant was 4 (interquartile ratio [IQR] 2-6), with 7 (IQR 3-10) categories perceived as beneficial but not owned. Most devices (88.4%) were acquired through self-pay. Common barriers to ownership were cost (63.6%) and installation difficulty (35.2%). Individuals with greater upper extremity (UE) impairment were significantly more likely to perceive benefit from voice assistants, smart plugs, smart bed controls, and smart televisions. Multivariate logistic regression identified higher education (odds ratio [OR]=1.97, p=0.03), higher income (OR=2.25, p<0.01), and greater UE impairment (OR=1.75, p=0.03) as significant predictors for owning ≥4 categories of MSHT. MSHT was highly valued among individuals with SCI/D, though the rate of ownership of MSHT was low, especially for costlier or more complex devices. Barriers stem largely from affordability and limited support for installation and training. Integrating MSHT training into rehabilitation programs and improving funding, education, and service delivery could enhance access and autonomy for people with SCI/D.