Beyond Walking: Exploring Functional Use of Exoskeletons in the Home Environment

Authors

• Sue D. Dahl-Popolizio, A. T. Still UniversityFollow
• Adam M. Story, A.T. Still UniversityFollow
• Thomas Hartman, A. T. Still UniversityFollow
• Lacee Andrews, A. T. Still UniversityFollow
• Jennifer Radziak, A.T. Still UniversityFollow
• Angela Zhu, A. T. Still UniversityFollow
• Joelly Lobato de Faria OTD, MS, OTR/L, A. T. Still UniversityFollow

Abstract

Purpose: This pilot study was completed to determine whether individuals with paraplegia can perform activities of daily living (ADL) and instrumental activities of daily living (IADL) in their homes using a personal exoskeleton. The physiological effects of using an exoskeleton for these tasks were investigated as well. Methods: In this mixed-methods observational study, participants with paraplegia were observed using an exoskeleton to complete ADLs and IADLs in their homes. Performance and satisfaction with performance were measured before and after home exoskeleton use with the Canadian Occupational Performance Measure (COPM). The level of importance of completing ADLs and IADLs to the individual using an exoskeleton was assessed with the Reintegration to Normal Living Index-modified (RNLI-M), and pain differences between exoskeleton and wheelchair use were evaluated using the Numeric Pain Rating Scale (NPRS). Changes in bowel and bladder function with exoskeleton use were assessed, and a survey was used to identify barriers to exoskeleton use. Results: Twelve participants with paraplegia due to chronic spinal cord injury completed the study. All participants performed kitchen tasks, and 10 completed grooming tasks. Following home observations, significant improvements were observed in COPM performance (P = .008), satisfaction with performance (P = .003), and RNLI-M scores (P = .04). Participants reported lower levels of pain on the NPRS while using the exoskeleton compared to their wheelchair (P = .01), and eight noted improvements in bowel and bladder function. Reported barriers to use included the need for a companion and limited device agility. Conclusion: Personal exoskeleton use at home may enable individuals with paraplegia to perform selected ADLs and IADLs in standing. According to these assessment outcomes, it is also associated with improved perceived ADL and IADL performance and satisfaction, lower levels of pain when using the device, and improvements in bowel and bladder function. Including an occupational therapist on the exoskeleton training team can ensure the functional potential of the device is addressed.

Clinical Trials Registry: ClinicalTrials.gov record no. 2023-196.

Author Bio(s)

Dr. Sue Dahl-Popolizio, DBH OTR/L is an occupational therapist (OT), professor, and Research Consultant for the A. T. Still University OT Department, with a doctorate in behavioral health, and 33 years’ experience across clinical settings. Research includes technology and telehealth in rehabilitation, and OT on primary care teams.

Dr. Adam Story PT, DPT, OTR/L, OTD, MTC, FNAP, holds doctoral degrees in Occupational Therapy (OTD) and Physical Therapy (DPT), is certified in Manual Therapy (MTC), and a Fellow of National Academies of Practice (FNAP). He is Assistant Professor in the Occupational Therapy Department at A.T. Still University

Dr. Thomas Hartman, DMSc, PA-C, is an assistant professor in the Physician Assistant program at A.T. Still University (ATSU), where he also serves as the Director of Student Progression and Retention. He has over 15 years of clinical experience in emergency medicine, including level 1 trauma.

Dr. Lacee Andrews OTD, OTR/L, CNS, CSRP, A.T. Still University Department of Occupational Therapy. She holds a Post-Professional Doctorate in Occupational Therapy, is a Certified Neuro Specialist (CNS) and Certified Stroke Rehabilitation Professional (CSRP) with clinical expertise as an acute care occupational therapist at Barrow Neurological Institute.

Angela Zhu is a fourth-year osteopathic medical student at A.T. Still University with a strong commitment to advancing health equity. She currently serves as a research assistant in the Department of Occupational Therapy, contributing to interdisciplinary projects aimed at improving care delivery.

Dr. Jennifer Radziak, OTD, OTR/L, CHT is Program Director and Assistant Professor in the Occupational Therapy Department at A.T. Still University. She has over 12 years clinical experience in outpatient, assisted living, and skilled nursing settings. Dr. Radziak has advanced clinical training as a Certified Hand Therapist (CHT).

Dr. Joelly Lobato de Faria, OTD, MS, OTR/L, received her Doctorate in Occupational Therapy from Creighton University in 2024 and her Masters in Occupational Therapy from San Jose State in 2015. Joelly works at Barrows Neurological Institute in inpatient rehabilitation with an emphasis on robotics

Acknowledgements

We gratefully acknowledge Ashley White, BASc, and Curtis Bay, PhD. Ashley provided valuable assistance with project coordination, including researcher travel logistics. Dr. Bay provided support and encouragement throughout the process and completed the data analysis for the study. Their contributions were invaluable and supported the smooth execution of this research.

Recommended Citation

Dahl-Popolizio SD, Story AM, Hartman T, Andrews L, Radziak J, Zhu A, et al. Beyond Walking: Exploring Functional Use of Exoskeletons in the Home Environment. The Internet Journal of Allied Health Sciences and Practice. 2026 Sep 01;24(3), Article 2.