A call to action: Community-integrated development enhances development of rehabilitation technology

Although there are many innovative technology innovations in rehabilitation, many of these innovations fail to provide a beneficial impact on users. There are key gaps in most current technology design processes which inhibit development of meaningful, impactful, and lasting solutions to improve health and wellness rehabilitative outcomes for our communities. It is essential to take a step back and first connect and identify the users or stakeholders and their problems, need, and personal desires around their needs before designing and applying solutions. Significant and meaningful continuous involvement and equal integration with all stakeholders, especially the end user, in the design process is essential for development.

As a systems engineer, entrepreneur in the rehabilitation technology field, clinical researcher, a C4 tetraplegic, with limited use of my arms and a full-time wheelchair user, I have been part of this design process many times and developed some meaningful products and some that still needed improvement. As an engineer who lives the disability life experience every day, being fully integrated in the design process created efficiencies in the development and prevented poor decisions from advancing early-on when developing solutions from realities that were not apparent to people who did not live that life experience 24/7. Moreover, the value of lived experience design integration must not be taken lightly. For many teams, individual personality characteristics, close-minded thinking, egos, and the ability to hear the feedback of lived experience individual negatively impacts the development process, which far too often fails to translate to a successful technology adoption. Assistive technology development is a challenging process, often influenced by deadlines, costs, essential design limitations, and knowledge of technologies or systems that can be used, enhanced, or modified/integrated to achieve the solution. We must do better at tightly incorporating members of the community with lived experience into the development team and process. It is also important to diversify the lived experience and all stakeholder involvement so that it reflects not just one cross-sectional view, but a wider view of the population that is meant to be impacted. Including multiple individuals over time while maintaining an integrated core development team allows for fresh perspective and facilitates continuous improvement.

Successes from general consumer virtually integrated exercise and augmented reality products such as wearable fitness tracking watches, integrations of interactive video stationary cycling and exercise equipment, and video game sports that require physical movement have meaningfully revolutionized the way that we view and manage our recreation, health, and wellness with engaging responsive feedback and challenges. These successful innovations are rooted in easy to use and enjoyable experiences that emotionally empower and reward users. They have transformed abilities to increase in-home rehabilitation and maintain coherence with personal health goals. However, these technologies have been developed over many iterations and within the consumer marketplace for the general population. Challenges exist with meeting the needs for specialized populations and rehabilitative needs and specific outcomes that add complexity to the development process. Furthermore, design for reimbursement and regulatory compliance is commonly overlooked in early design and development processes and must be understood and addressed early in the design process.

We have an opportunity to improve the outcomes of rehabilitative and assistive technology by involving and incorporating people with lived experiences in a fully inclusive design and development processes. We should not only aim to provide a functional outcome, but also comprehend what inspires and gratifies individuals to help them reach their goals. Engaging and including individuals with lived experiences in all stages of product development process will strongly enhance and increase the value and potential for achieving lasting and better outcomes in rehabilitation technology.