# PWR-204 — Exoskeleton-assisted mobility: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 14 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Common household or practice equipment — Declared Exoskeleton-assisted mobility fixture: In a rehabilitation gym, the team selects a sit-to-stand and two parallel-bar steps in a configured exoskeleton. The therapist and trained spotter control the device and progression.; Setup aid for Inspect body and device: Clear the gym, prepare parallel bars or prescribed aid and keep the stop control reachable.; Exoskeleton-assisted mobility log: Device-on mobility, assistance level, falls, fatigue and personally relevant independence plus delayed device-off walking outcomes; retain Exoskeleton-assisted mobility errors, assistance, stop and fallback.; Exoskeleton evidence table: from “Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial”, extract participants, device, session programme, assistance, walking outcomes and adverse events. Compare those fields with the multicentre exoskeleton trial and add the WHO/UNICEF report’s person-centred goal and service support. The clinical team may use the table for measurement categories, never to copy a dose or clear stepping. Space: Room-scale practice space Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Focused research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context In the rehabilitation gym, the clinical team controls exoskeleton fit, assistance and progression through one sit-to-stand and two parallel-bar steps. The learner teaches back stop cues, reports symptoms and performs the emergency-stop response with the spotter. Completing that sequence does not imply independent mobility, lower fall risk or device-off recovery. Target outcome: Under the clinical team’s control, the learner teaches back stop cues and completes an authorised sit-to-stand or short stepping task with assistance, symptoms and adverse events logged. ### Authority and setup conditions - Obtain same-day clinical clearance and confirm trained staff, approved device and emergency plan. - Clear the gym, prepare parallel bars or prescribed aid and keep the stop control reachable. - Start check for Exoskeleton-assisted mobility: The authorised task and responsible staff are named. - Top-of-sheet stop for Exoskeleton-assisted mobility: Stop immediately for chest pain, marked breathlessness, dizziness, faintness, new weakness, severe headache, pain or autonomic symptoms. ### Required or supplied materials - Declared Exoskeleton-assisted mobility fixture: In a rehabilitation gym, the team selects a sit-to-stand and two parallel-bar steps in a configured exoskeleton. The therapist and trained spotter control the device and progression. - Setup aid for Inspect body and device: Clear the gym, prepare parallel bars or prescribed aid and keep the stop control reachable. - Exoskeleton-assisted mobility log: Device-on mobility, assistance level, falls, fatigue and personally relevant independence plus delayed device-off walking outcomes; retain Exoskeleton-assisted mobility errors, assistance, stop and fallback. - Exoskeleton evidence table: from “Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial”, extract participants, device, session programme, assistance, walking outcomes and adverse events. Compare those fields with the multicentre exoskeleton trial and add the WHO/UNICEF report’s person-centred goal and service support. The clinical team may use the table for measurement categories, never to copy a dose or clear stepping. ## 1. Confirm clinical goal and clearance The clinician defines the exact sit-to-stand or step task, device mode, assistance and non-goals after health screening. Why: The authorised task and responsible staff are named. Success check: The authorised task and responsible staff are named. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The authorised task and responsible staff are named.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Inspect body and device The team checks skin, straps, joint alignment, footwear, battery, fasteners, software mode and surrounding floor. Why: A signed checklist is complete before power-on. Success check: A signed checklist is complete before power-on. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “A signed checklist is complete before power-on.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Teach back commands The learner identifies start, pause and emergency-stop cues and states what to do for dizziness, pain or loss of balance. Why: The learner can point to or communicate every stop response. Success check: The learner can point to or communicate every stop response. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner can point to or communicate every stop response.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Rehearse with device stationary In the supported start position, practise weight shift or cue timing without initiating the full movement. Why: Alignment and communication remain stable. Success check: Alignment and communication remain stable; verify it in the lower-limb exoskeleton sequence. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Alignment and communication remain stable; verify it in the lower-limb exoskeleton sequence.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Complete the selected transition On the therapist’s count, follow the device and therapist cues for sit-to-stand while spotters maintain the approved positions. Why: The transition reaches the planned supported stance without unplanned step or strap shift. Success check: The transition reaches the planned supported stance without unplanned step or strap shift. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The transition reaches the planned supported stance without unplanned step or strap shift.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Add only authorised steps If the clinician approves, take two parallel-bar steps at the set speed; do not add distance, speed or repetitions. Why: Each step and assistance level is recorded. Success check: Each step and assistance level is recorded. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Each step and assistance level is recorded.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Practise a stop The clinician stages a pause; the learner gives the stop signal and the team returns to the approved supported state. Why: Stop communication is timely and the device reaches safe support. Success check: Stop communication is timely and the device reaches safe support. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Stop communication is timely and the device reaches safe support.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. Debrief and recheck Record assistance, alignment, fatigue, pain, blood-pressure or other clinician-selected measures, near falls and skin; the clinician decides continuation. Why: Device-on performance and any later device-off outcome are kept separate. Success check: Device-on performance and any later device-off outcome are kept separate. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Device-on performance and any later device-off outcome are kept separate.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.