Abstract
BackgroundWearable exoskeletons can be a powerful tool for the facilitation of ambulation of complete Spinal Cord Injury (SCI) subjects, which has several psychological and physical advantages. However, exoskeleton control is difficult for this group of users and requires a long period of training. People with SCI not only lack the motor control, but also miss the sensory information from below the level of the lesion, which is for example very important in their perception of body posture and makes balancing with an exoskeleton difficult.It is hypothesized that through sensory substitution part of the missing sensory information can be provided and might thereby improve the control of an exoskeleton. However, it is not known which information would be most important to receive while using an exoskeleton and how this feedback should be provided.MethodsTo investigate the preferences of users of an exoskeleton, a questionnaire was filled out by 10 SCI subjects who underwent a training program with a commercial exoskeleton (ReWalk).The questionnaire consisted of questions about the use of the exoskeleton to identify which information is missing and which instructions from the therapists were needed to be able to control the exoskeleton. The second part of the questionnaire focused on the possibilities of sensory feedback and preferences for stimulation methods (auditory, vibrotactile or visual) and feedback timing (discrete or continuous) were investigated. Furthermore, six options for feedback parameters (step initiation, continuous and discrete gait phases, foot position and mediolateral and anteroposterior weight shift) were proposed and the respondents were asked to indicate their preferences.ResultsThree feedback parameters (feedback about mediolateral and anteroposterior weight shift and feedback about step initiation) were considered as possibly helpful by the respondents. Furthermore, there were slight preferences for the use of vibrotactile (over auditory and visual) and discrete (over continuous) feedback.ConclusionsThe answers of the respondents on the optimal feedback parameters were rather variable and therefore it is recommended to let the users choose their preferred feedback system during a training session with several feedback options. However, there are slight preferences for the use of vibrotactile stimulation provided in a discrete way.
Highlights
Wearable exoskeletons can be a powerful tool for the facilitation of ambulation of complete Spinal Cord Injury (SCI) subjects, which has several psychological and physical advantages
Subjects A link to the online questionnaire was distributed via email to 14 subjects who had been participating in a study with the ReWalk wearable exoskeleton at the Sint Maartenskliniek in Nijmegen, the Netherlands, in the period from September 2015 to September 2017
Current exoskeleton use The responses of the subjects to the general, open questions (1–5) about the use of the wearable exoskeleton during training showed hardly any overlapping answers over the respondents
Summary
Wearable exoskeletons can be a powerful tool for the facilitation of ambulation of complete Spinal Cord Injury (SCI) subjects, which has several psychological and physical advantages. Over the last few years, wearable exoskeletons used to facilitate ambulation of people with spinal cord injury (SCI), have developed quickly [1,2,3,4] and resulted in the introduction of some exoskeletons to the market [5,6,7,8,9]. These exoskeletons are mainly used in rehabilitation centers. Sensory reweighting takes place after the loss of the somatosensory input [13], one can expect that the lack of somatosensory input will negatively influence the capabilities of these patients in balancing with and controlling an exoskeleton
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