# Exploring Barriers and Enablers for the Intention to Use Assistive Robotics Among People With Spinal Cord Injury and Those Involved in Their Care: Qualitative Study

## TL;DR

This study explores how people with spinal cord injuries and their caregivers perceive and use assistive robotics, highlighting barriers and enablers to adoption.

## Contribution

The study introduces a qualitative analysis of sociotechnical and emotional factors influencing the intention to use assistive robotics among people with spinal cord injuries.

## Key findings

- Participants identified practical constraints like costs and access as major barriers to using assistive robotics.
- Enablers included visions of increased self-efficacy and shared technological imaginaries about future robotics.
- Emotional and social concerns, such as safety and social norms, significantly influenced perceptions of robotic assistance.

## Abstract

Spinal cord injury (SCI) may, and often does, profoundly reshape daily life, altering physical abilities, social roles, and personal identities. While assistive technologies, including assistive robotics, are often framed as solutions to re-establish independence, their adoption is shaped by practical, emotional, and social considerations as well as functional qualities. Individuals with SCI, their relatives, and health care professionals need to navigate complex dynamics when encountering assistive robotics. Understanding how assistive technologies are perceived and positioned in everyday life may help developers and designers create assistive robotics that are meaningful and useful for intended users.

The aim of this qualitative study was to explore how individuals with SCI, relatives, and

health care professionals working with patients with SCI perceive and describe the possibilities and limitations of assistive robotics. The study sought to understand the factors that influence the intention to use assistive robotics among individuals with SCIs.

We used a qualitative approach, conducting semi-structured interviews and participatory workshops in Sweden and Spain. In total, the study involved 18 interview participants with SCI, 21 workshop participants with SCI, 12 relatives, and 26 health care professionals. The interviews and workshops elicited reflections on participants’ experiences, expectations, and concerns regarding assistive robotics in general and supernumerary robotic limbs in particular. Data were analyzed using reflexive thematic analysis, with a focus on interpreting the meanings embedded in participants’ narratives.

The analysis showed that participants’ engagement with assistive robotics was influenced by expectations of technological benefits and by practical constraints in everyday life. The main barriers identified were practical constraints, including the subthemes “navigating a changing reality,” “difficulties with awareness and access” and “concerns about costs”; and interaction with robots, including “doubts about meaningfulness,” “uncertainty regarding reliability and safety,” “uneasiness about competence” and “apprehension of social norms.” Participants’ visions of enhanced self-efficacy through assistive robotics were described as important enablers of the intention to use and motivation to try assistive robotics. Shared expectations and concerns about future technologies (technological imaginaries) also influenced how participants talked about assistive robotics.

Rather than presenting assistive robotics as an inevitable progression toward greater autonomy, this study highlights the complexities and contingencies that shape how individuals relate to assistive robotics in general and supernumerary robotic limbs in particular. Participants’ responses illustrate that robotic assistance is not merely a question of technological feasibility but is deeply entangled with embodied experiences, shifting identities, and evolving social relations. While visions of independence through assistive robotics remain compelling among participants, sociotechnical imaginaries coexist with concerns about meaningful engagement, reliability, safety, competence, and social norms, as well as challenges related to transition periods, costs, and limited awareness and access to assistive robotics.