“I feel a lot more connected with my body after a session”: a focus group exploration of the impact of exoskeleton walking on highly experienced robotic exoskeleton walkers

Robotic exoskeleton walking has become increasingly prevalent in the management of paralysis. To support better integration into clinical practice, there is a need to understand the users’ perceptions of the effects of exposure to large volumes of robotic walking. This study aims to describe the patient perspective of exoskeleton walking for the expert user. Focus groups were conducted with 19 participants (group size range 3–4) who had experienced large numbers of exoskeleton walking sessions (>24). The qualitative methodology used an interpretive phenomenological design and themes were identified using reflexive thematic analysis. Four themes were identified; feeling a perception of normality again, preference for exoskeleton technology, feeling a part of a community, and sustained benefits and therapeutic effects. The perception of feeling normal again, which grew with experience in the device contributed to a positive experience with exoskeleton walking. Experienced users of exoskeletons develop a rich and meaningful perception of robotic walking over time. In addition to the physical benefits, a sense of community and general preference for exoskeleton walking, they develop a deeper meaning around the experience of walking that may be linked to embodiment of the device and/or re-embodiment of the paralysed limbs. Regular exoskeleton walking of once per week seems to help manage the symptoms of paralysis, support mood and maintain physical health and wellbeing Set the expectation with new users that it will take time to become adept at using an exoskeleton and that the initial benefits and hope exoskeleton walking offers may change with experience Ambulant patients with neurological conditions like spinal cord injury may improve their gait as well as experience psychosocial benefits