Emotional Labor and the Problem of Exploitation in Roboticized Care Practices: Enriching the Framework of Care Centred Value Sensitive Design.

Care ethics has been advanced as a suitable framework for evaluating the ethical significance of assistive robotics. One of the most prominent care ethical contributions to the ethical assessment of assistive robots comes through the work of Aimee Van Wynsberghe, who has developed the Care-Centred Value-Sensitive Design framework (CCVSD) in order to incorporate care values into the design of assistive robots. Building upon the care ethics work of Joan Tronto, CCVSD has been able to highlight a number of ways in which care practices can undergo significant ethical transformations upon the introduction of assistive robots. In this paper, we too build upon the work of Tronto in an effort to enrich the CCVSD framework. Combining insights from Tronto's work with the sociological concept of emotional labor, we argue that CCVSD remains underdeveloped with respect to the impact robots may have on the emotional labor required by paid care workers. Emotional labor consists of the managing of emotions and of emotional bonding, both of which signify a demanding yet potentially fulfilling dimension of paid care work. Because of the conditions in which care labor is performed nowadays, emotional labor is also susceptible to exploitation. While CCVSD can acknowledge some manifestations of unrecognized emotional labor in care delivery, it remains limited in capturing the structural conditions that fuel this vulnerability to exploitation. We propose that the idea of privileged irresponsibility, coined by Tronto, helps to understand how the exploitation of emotional labor can be prone to happen in roboticized care practices.

Robot-Mediated Nudges for Workplace Health: Not a One-Size-Fits-All Modeling Problem.

Prolonged sedentary behavior in the vast population of office and remote workers leads to increased cardiovascular and musculoskeletal health challenges, and existing solutions for encouraging breaks are either costly health coaches or notification systems that are easily ignored. A socially assistive robot (SAR) for promoting healthy workplace practices could provide the physical presence of a health coach along with the scalability of a notification system. To investigate the impact of such a system, we implemented a SAR as an alternative break-taking support solution and examined its impact on individual users' break-taking habits over relatively long-term deployments. We conducted an initial two-month-long study (N = 7) to begin to understand the robot's influence beyond the point of novelty, and we followed up with a week-long data collection (N = 14) to augment the dataset size. The resulting data was used to inform a robot behavior model and formulate possible methods of personalizing robot behaviors. We found that uninterrupted sitting time tended to decrease with our SAR intervention. During model formulation, we found participant responsiveness to the break-taking prompts could be classified into three archetypes and that archetype-specific adjustments to the general model led to improved system success. These results indicate that break-taking prompts are not a one-size-fits-all problem, and that even a small dataset can support model personalization for improving the success of assistive robotic systems.

An observational study of the impact of professional walking aid prescription on gait parameters for individuals with suspected balance impairments.

Background: The primary management strategy for gait impairment is the adoption of a walking aid. However, there are no established criteria upon which to base a decision regarding the need for a walking aid. It appears clinicians prescribe aids based on preference, clinical experience and intuition rather than standardised objective rationale. This may contribute to the inconsistent gait response to walking aids reported in the published literature. Understanding gait changes resulting from gait aid usage may have significant impact on clinical practice by improving confidence of prescribing clinicians and compliance of walking aid usage by patients, maximising the benefits of use, and reducing any risks associated with non-use or inappropriate use, of the walking aid. Research question: Do professionally prescribed walking aids improve gait parameters? Methods: This is a secondary data analysis of a cross-sectional study where participants, identified by healthcare staff requiring a mobility assessment due to potential balance impairment of any cause, walked a 20-m straight walking course under three different walking conditions (no aid, walking stick and 4-wheeled walker). Fifty-eight participants were recruited. Commonly reported spatial and temporal gait parameters were assessed using a validated gait analysis device. Changes in gait parameters across the three conditions were compared, noting the individual's professionally prescribed aid and interpreting changes in parameters towards outcomes of the 'no aid required group'. Results and significance: Gait cycle, cadence, stance, swing and stride length during unaided walking were significantly changed when a walking stick was prescribed (p < 0.05). Stance, swing, double support, stride length, speed, max toe clearance and minimum toe clearance were significantly changed when a 4-wheel walker was prescribed (p < 0.05). Professional walking aid prescription improves some gait parameters. A greater number and magnitude of gait parameter improvements were seen in people requiring a 4-wheel walker than people requiring a walking stick.

Bridging the Digital Divide: Using Free Open-Source Tools to Expand Access to Shared-Use Computers in Schools and Libraries.

The use of computers in everyday life has moved from hobby and technical professional use to being essential to almost all activities in people's lives. However, not everyone has a computer themselves or access to the internet at home. To address this, society provides computers that people can use at school, in libraries, at job centers, in community centers, and at government service centers. However, these are not accessible to those who need assistive technologies (AT), and they are not allowed to install the AT they need to use the computers. This puts people who need to use AT at a severe disadvantage to their peers at best and, at worst, prevents them from participating at all where computer use is required. This is a problem when a person is required to use a particular computer instead of their own and is a total barrier to computer use for those who do not own their own computer. Proposed is the installation of a free utility on all public or shared use computers that both a) exposes the built-in accessibility features in computers to make them easier to discover and use, and b) allows AT users to have any AT the need automatically installed on any computer they encounter, and then set up just for them. When they are done, the AT disappears.

Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study.

BACKGROUND: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. OBJECTIVE: This study aims to examine the characteristics and use patterns of SARs. METHODS: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. RESULTS: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. CONCLUSIONS: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions.

What stakeholders with neurodegenerative conditions value about speech and accuracy in development of BCI systems for communication.

This research examined values of individuals with neurodegenerative conditions about features of speed and accuracy as they consider potential use of augmentative and alternative communication brain-computer interface systems (AAC-BCI). Sixty-six individuals with neurodegenerative disease responded to prompts about six hypothetical ethical vignettes. Data were analyzed with qualitative content analysis. The following themes emerged. (1) Disease progression may contribute to the trade-off between speed and accuracy with AAC-BCI systems. (2) Individual experiences with technology use inform their views about the speed-accuracy trade-off. (3) There is a range of views about how slow or inaccurate communication may impact relationships, the integrity of a message, and quality of life. (4) Design solutions are proposed to address trade-offs in AAC-BCI systems. With the rapid development of AAC-BCI systems, user-centered design must integrate values of potential end-users illustrating that context, partner, message, and environment impact the prioritization of speed or accuracy in any communication exchange.

Bridging the gap: challenges and opportunities of assistive technology loan library systems for individuals with intellectual disabilities in the United States.

PURPOSE: In an increasingly technology-driven world, this study explores the accessibility of assistive technology for individuals with intellectual disabilities through assistive technology loan libraries. Assistive technology refers to devices or systems that enhance the ability of individuals with and without disabilities to function and undertake activities of daily living. MATERIALS AND METHODS: The study, grounded in the Social Determinants of Health framework, employed multiple methods including both qualitative (interviews) and quantitative (questionnaire) methods, involving 19 participants comprising assistive technology professionals and users. RESULTS: Key findings from the study underscore the pivotal role of assistive technology loan libraries, which lend various assistive devices to individuals, enabling them to try these technologies before making a long-term commitment. However, challenges, such as a restricted variety of devices and extended waiting periods for access were highlighted. The research points to a need for improved training for both staff at the loan libraries and the users of the technology. It also suggests that policy enhancements are required to better align with rapid technological advancements and address the uneven regional distribution of these technologies. CONCLUSIONS: Participants in the study highlighted the importance of expanding the range of assistive devices available in these libraries and improving the efficiency of the service they provide. The study advocates for targeted efforts to enhance the effectiveness and accessibility of assistive technology loan libraries, highlighting their critical role in empowering individuals with intellectual disabilities.

Assistive Technology (AT) loan libraries significantly enhance access to vital technologies for individuals with intellectual disabilities, enabling trials before purchase.Challenges like limited device variety, extended wait times, and a need for improved staff training must be addressed to optimize loan libraries' effectiveness.Enhancements in policy, funding, and device availability are crucial to ensure equitable AT access and support rehabilitation goals.Collaboration between AT professionals, users, and policymakers is essential for developing responsive, user-centered AT loan library services.Strengthening awareness and education about AT options can empower users and caregivers, fostering greater independence and participation in daily activities.

Phasor-Based Myoelectric Synergy Features: A Fast Hand-Crafted Feature Extraction Scheme for Boosting Performance in Gait Phase Recognition.

Gait phase recognition systems based on surface electromyographic signals (EMGs) are crucial for developing advanced myoelectric control schemes that enhance the interaction between humans and lower limb assistive devices. However, machine learning models used in this context, such as Linear Discriminant Analysis (LDA) and Support Vector Machine (SVM), typically experience performance degradation when modeling the gait cycle with more than just stance and swing phases. This study introduces a generalized phasor-based feature extraction approach (PHASOR) that captures spatial myoelectric features to improve the performance of LDA and SVM in gait phase recognition. A publicly available dataset of 40 subjects was used to evaluate PHASOR against state-of-the-art feature sets in a five-phase gait recognition problem. Additionally, fully data-driven deep learning architectures, such as Rocket and Mini-Rocket, were included for comparison. The separability index (SI) and mean semi-principal axis (MSA) analyses showed mean SI and MSA metrics of 7.7 and 0.5, respectively, indicating the proposed approach's ability to effectively decode gait phases through EMG activity. The SVM classifier demonstrated the highest accuracy of 82% using a five-fold leave-one-trial-out testing approach, outperforming Rocket and Mini-Rocket. This study confirms that in gait phase recognition based on EMG signals, novel and efficient muscle synergy information feature extraction schemes, such as PHASOR, can compete with deep learning approaches that require greater processing time for feature extraction and classification.

Community-based, inclusive design of a 3D tactile map to enable playground navigation for children who are visually impaired and blind.

The LSU Community Playground Project (LSUCPP) collaborates with communities (especially the true experts at play, the children) to design and build playgrounds that reflect "the soul of the community." One member of the LSUCPP undertook a research project in an effort to design better playgrounds for use by children who are visually impaired or blind. A recommendation from this research was to provide a 3D-printed tactile map of each play area, such that children who were visually impaired or blind could feel the location and type of equipment and ground surfaces prior to entering a playground, which would enable them to play independently. In this paper, we tell the story of how engineering students and faculty collaborated with children with visual impairments or blindness and their teachers and professional staff to co-design and build a 3D printed tactile map at the Louisiana School for the Visually Impaired (LSVI). Specifically, we detail how we co-designed this artifact, the ways in which the artifact developed due to this inclusive approach, briefly present the design, and discuss how engineers engaged in the design of assistive technologies can put inclusive design principles and community-based design processes into action.

Development of a Three-Finger Adaptive Robotic Gripper to Assist Activities of Daily Living.

A significant number of individuals in the United States use assistive devices to enhance their mobility, and a considerable portion of those who depend on such aids require assistance from another individual in performing daily living activities. The introduction of robotic grippers has emerged as a transformative intervention, significantly contributing to the cultivation of independence. However, there are few grippers in the fields, which help with mimicking human hand-like movements (mostly grasping and pinching, with adoptive force control) to grasp and carry objects. Additionally, the data are not available even on how many Activities of Daily Living (ADL) objects they can handle. The goal of the research is to offer a new three-fingered gripper for daily living assistance, which can both grasp and pinch with adaptive force, enabling the capabilities of handling wide-ranging ADL objects with a minimal footprint. It is designed to handle 90 selective essential ADL objects of different shapes (cylindrical, irregular, rectangular, and round), sizes, weights, and textures (smooth, rough, bumpy, and rubbery). The gripper boasts a meticulously engineered yet simple design, facilitating seamless manufacturing through 3D printing technology without compromising its operational efficacy. The gripper extends its functionality beyond conventional grasping, featuring the capability to pinch (such as holding a credit card) and securely hold lightweight objects. Moreover, the gripper is adaptable to grasping various objects with different shapes and weights with controlled forces. In evaluation, the developed gripper went through rigorous load tests and usability tests. The results demonstrated that the users picked and placed 75 objects out of 90 daily objects. The gripper held and manipulated objects with dimensions from 25 mm to 80 mm and up to 2.9 kg. For heavy-weight objects (like books) where the centroid is far apart from the grasping areas, it is difficult to hold them due to high torque. However, objects' textures have no significant effect on grasping performance. Users perceived the simplicity of the gripper. Further investigation is required to assess the utility and longevity of grippers. This study contributes to developing assistive robots designed to enhance object manipulation, thereby improving individuals' independence and overall quality of life.

Use of Braille in the Workplace by People Who Are Blind.

Interest in the benefits of braille for people who are blind is high among professionals in the blindness field, but we know little about how braille is used in the workplace. The broad purpose of this study was to learn how employed people who are blind use braille on the job. Specific topics investigated included: work tasks refreshable braille technology (RBT) is used for, personal and job characteristics of RBT users compared to non-users, and factors associated with RBT use among workers with at least moderate braille skills. This study utilized data from 304 participants in a longitudinal research project investigating assistive technology use in the workplace by people who are blind. Two-thirds of our participants used braille on the job, and more than half utilized RBT. Workers who used RBT did not necessarily use it for all computer-related tasks they performed. RBT use was generally not significantly related to job characteristics, except for working for a blindness organization. RBT use was not significantly related to general personal characteristics but it was significantly different based on disability-related characteristics. Only older age and higher braille skills were significantly associated with RBT use on the job in a multivariate logistic regression model.

Implementation of socially assistive robots in geriatric care institutions: Healthcare professionals' perspectives and identification of facilitating factors and barriers.

Introduction: The successful integration of socially assistive robots in geriatric care settings hinges on the attitudes and opinions of healthcare professionals. This study explored their needs, expectations, and perceptions regarding robot use, including facilitating factors and barriers to implementation. Methods: Twenty professionals participated in semi-structured interviews that covered topics such as robot applications, perceived value, acceptance criteria, prerequisites for deployment, ethical considerations, and design attributes. These interviews were analyzed using a deductive qualitative approach guided by the European Network for Health Technology Assessment model (version 3.0). Results: Results indicated that professionals generally viewed robots favorably, noting their usefulness in various non-intimate tasks like meal assistance and toileting. Ease of use was identified as a critical factor for robot adoption in geriatric care. Furthermore, the necessity of educating all stakeholders and providing comprehensive training to professionals emerged as essential for successful implementation. The discussions also included financial and ethical issues related to the introduction of these technologies. Conclusion: These findings will contribute to develop guidelines for designing and deploying socially assistive robots that align with the preferences and requirements of geriatric care professionals.

Perceived Vulnerability to Disability-Related Victimization in People With Multiple Sclerosis: Community Survey on Risk and Protective Factors.

BACKGROUND: The perception that one is at increased risk of interpersonal victimization or violence can deleteriously affect community participation and quality of life. Race, sex, and disability status, often associated with use of an assistive mobility device (AD), are known correlates of perceived risk of victimization; however, almost no research has explored how these variables intersect for individuals with multiple sclerosis (MS), and none have sought to identify potential risk and protective factors. METHODS: Data for the present study come from a single time point derived from a 10-year longitudinal survey of 446 individuals with MS. Lifetime trauma exposure, personal resilience and self-efficacy, control over participation, and perceived risk of interpersonal victimization due to disability were all assessed via self-report. Statistical analyses included analysis of covariance with participants stratified by race/ethnicity, sex, and AD use. RESULTS: After controlling for lifetime trauma exposure and severity of physical impairment, the use of an AD was significantly associated with greater perceived risk of victimization due to disability. Further, people with MS from racial and ethnic minority groups who used ADs had the highest perceived risk relative to all other groups. Higher levels of perceived risk were associated with a lower sense of control over community participation, lower resilience, and lower disease management self-efficacy. CONCLUSIONS: Visible indicators of disability may contribute to perceptions of vulnerability, especially among people with MS who are racially and ethnically marginalized. Clinicians should be aware of how perceived vulnerability may impact a sense of control over community participation, particularly when educating patients on AD use.

A mixed methods, cluster randomized control trial to examine assistive technology use to support early literacy in preschool children with disabilities.

This mixed methods study examined the impact of a multi-faceted professional development (PD) program for preschool teachers and classroom assistants on teacher-supported assistive technology (AT) use and early literacy development of children with disabilities. Four special education preschools were randomized into intervention (2 schools, 9 teachers, 50 children) and waitlist control (2 schools, 17 teachers, 42 children) groups. The 24-week PD included online modules, coaching, and AT device kits. Pre-post gains in children's AT use and early literacy skills were analyzed using χ2 and repeated measures ANOVA. Teacher interviews and reflective commentaries were analyzed using Framework Analysis methodology. From pre- to post-test, the percent of children in the intervention group using some form of AT rose from 36 to 80%. The percent of children using AT in the control group went from 45 to 62%. The difference in change between the two groups was statistically significant, χ2 = 13.93, p=.001. Gains in early literacy skills were not significantly different across groups, F(1,90)=0.010, p=.922. Analysis of the qualitative data revealed three themes: the positive impact of AT on child engagement and participation, the importance of individualizing AT for each student, and barriers teachers faced in AT implementation. The PD program had a positive effect on children's AT use but not on gains in early literacy. Teachers' comments highlighted the nuanced relationship between AT use and literacy outcomes, suggesting the need for more targeted implementation of AT during literacy activities.

This research emphasized the importance of a comprehensive approach to PD that involves hands-on AT experience and coaching to bolster the AT practices of early childhood educators.The multi-faceted PD provided to preschool staff increased children's teacher-supported AT use but was not shown to result in increased gains in early literacy skills. These results highlight the need for additional focused research to elucidate how to best leverage AT to advance foundational early literacy competencies.Professional development that trains teachers and classroom assistants collaboratively as a unit promotes inclusive, empowered implementation and allows for integrated AT planning that utilizes assistants' expanding roles vis-á-vis students with disabilities.Future research should investigate flexible coaching approaches, just-in-time learning, and train-the-trainer models that cultivate site-based AT expertise and on demand resources to provide ongoing, tailored support and build local capacity, promoting sustainability and mitigating barriers like time constraints and high teacher turnover.

Determinants of Successful Implementation of Assistive Technologies for Dementia: Exploratory Survey.

Background: Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective: We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods: A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results: The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions: This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia.

Training and Familiarization with Industrial Exoskeletons: A Review of Considerations, Protocols, and Approaches for Effective Implementation.

Effective training programs are essential for safely integrating exoskeletons (EXOs) in industrial workplaces. Since the effects of wearable systems depend highly upon their proper use, lack of training of end-users may cause adverse effects on users. We reviewed articles that incorporated training and familiarization protocols to train novices on proper operation/use of EXOs. Findings showed variation in training methods that were implemented to train study participants in EXO evaluation studies. Studies also indicate that multiple (up to four) sessions may be needed for novice EXO wearers to match movement patterns of experts, and training can offer benefits in enhancing motor learning in novices. Biomechanical assessments and ergonomic evaluations can be helpful in developing EXO-specific training protocols by determining training parameters (duration/number of sessions and task difficulty). Future directions include development of personalized training approaches by assessing user behavior/performance through integration of emerging sensing technologies. Application of simulators and use of data-driven approaches for customizing training protocols to individuals, tasks, and EXO design are provided along with a comprehensive training framework. Discussed elements in this article can be helpful to exoskeleton researchers in familiarizing novice users to EXOs prior to evaluation, and to practitioners in developing protocols for training workforce.

Method for Bottle Opening with a Dual-Arm Robot.

This paper introduces a novel approach to robotic assistance in bottle opening using the dual-arm robot TIAGo++. The solution enhances accessibility by addressing the needs of individuals with injuries or disabilities who may require help with common manipulation tasks. The aim of this paper is to propose a method involving vision, manipulation, and learning techniques to effectively address the task of bottle opening. The process begins with the acquisition of bottle and cap positions using an RGB-D camera and computer vision. Subsequently, the robot picks the bottle with one gripper and grips the cap with the other, each by planning safe trajectories. Then, the opening procedure is executed via a position and force control scheme that ensures both grippers follow the unscrewing path defined by the cap thread. Within the control loop, force sensor information is employed to control the vertical axis movements, while gripper rotation control is achieved through a Deep Reinforcement Learning (DRL) algorithm trained to determine the optimal angle increments for rotation. The results demonstrate the successful training of the learning agent. The experiments confirm the effectiveness of the proposed method in bottle opening with the TIAGo++ robot, showcasing the practical viability of the approach.

Impact of a deep learning-based brain CT interpretation algorithm on clinical decision-making for intracranial hemorrhage in the emergency department.

Intracranial hemorrhage is a critical emergency that requires prompt and accurate diagnosis in the emergency department (ED). Deep learning technology can assist in interpreting non-enhanced brain CT scans, but its real-world impact on clinical decision-making is uncertain. This study assessed a deep learning-based intracranial hemorrhage detection algorithm (DLHD) in a simulated clinical environment with ten emergency medical professionals from a tertiary hospital's ED. The participants reviewed CT scans with clinical information in two steps: without and with DLHD. Diagnostic performance was measured, including sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. Consistency in clinical decision-making was evaluated using the kappa statistic. The results demonstrated that DLHD minimally affected experienced participants' diagnostic performance and decision-making. In contrast, inexperienced participants exhibited significantly increased sensitivity (59.33-72.67%, p < 0.001) and decreased specificity (65.49-53.73%, p < 0.001) with the algorithm. Clinical decision-making consistency was moderate among inexperienced professionals (k = 0.425) and higher among experienced ones (k = 0.738). Inexperienced participants changed their decisions more frequently, mainly due to the algorithm's false positives. The study highlights the need for thorough evaluation and careful integration of deep learning tools into clinical workflows, especially for less experienced professionals.

Impact of Contextual Factors on the Perceived Participation of People With Multiple Sclerosis and Gait Impairment Using Mobility Assistive Devices: A Qualitative Analysis.

INTRODUCTION: People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well-being. METHODS: We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz. RESULTS: Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations. CONCLUSIONS: This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment. PATIENT OR PUBLIC CONTRIBUTION: This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices. TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00025532.