Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation

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Successful integration of technology into clinical practice relies on therapists’ acceptance and endorsement. Our purpose is to share the perspectives of the occupational therapists who facilitate robot-assisted therapy and the benefits and challenges of practical implementation of the robot. Clinicians who worked with stroke survivors to research the usability, feasibility, and efficacy of the Harmony exoskeleton discuss their impressions of the technology on stroke rehabilitation. Overall, therapists expressed positive views on the therapeutic and adjunctive use of robot-assisted technology, emphasizing patient engagement, objective evaluations of progress, and ease of certain aspects of their role. Additional feedback highlighted the Harmony exoskeleton’s ability to promote neuromuscular re-education and foster neuroplasticity. Barriers to implementation include physical capabilities, patient suitability, technical difficulties, and the need for advanced quantitative feedback and data analysis. To maximize the impact of robot-assisted therapy in stroke rehabilitation, ongoing research and development are necessary to address identified challenges. Improved limb support, quantitative feedback, equipment reliability, and more levels of weight support for patients with higher levels of function may improve therapist acceptance of this device and may inform exoskeleton development." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-225", "name": "Occupational therapists’ perspectives on the use of exoskeletons for..." } } ] } Home Browse Occupational therapists’ perspectives on the use of exoskeletons for... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Muir B, Teng T, Nagle-Chrsitensen A et al. Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.12688/f1000research.161900.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Opinion Article Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] Brittney Muir https://orcid.org/0000-0002-0978-5524 1,2 , Tiffani Teng 1,3 , Avocet Nagle-Chrsitensen 1 , [...] Abbey Lacey 3 , Claira Geller 3 , Matthew Stutzenberger 3 , Ileana Howard 3,4 Brittney Muir https://orcid.org/0000-0002-0978-5524 1,2 , Tiffani Teng 1,3 , [...] Avocet Nagle-Chrsitensen 1 , Abbey Lacey 3 , Claira Geller 3 , Matthew Stutzenberger 3 , Ileana Howard 3,4 PUBLISHED 21 Feb 2025 Author details Author details 1 Department of Veterans Affairs, RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, 98144, USA 2 Department of Mechanical Engineering, University of Washington, Seattle, WA, 98144, USA 3 Department of Veterans Affairs, Rehabilitation Care Services, Seattle, WA, 98144, USA 4 Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, 98144, USA Brittney Muir Roles: Conceptualization, Data Curation, Funding Acquisition, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Tiffani Teng Roles: Data Curation, Writing – Original Draft Preparation Avocet Nagle-Chrsitensen Roles: Writing – Original Draft Preparation Abbey Lacey Roles: Data Curation, Writing – Review & Editing Claira Geller Roles: Data Curation, Writing – Review & Editing Matthew Stutzenberger Roles: Data Curation, Writing – Review & Editing Ileana Howard Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Health Services gateway. Abstract Robot-assisted therapy is a promising approach to enhance stroke rehabilitation, particularly in improving upper-limb function through intensive and repetitive training. Successful integration of technology into clinical practice relies on therapists’ acceptance and endorsement. Our purpose is to share the perspectives of the occupational therapists who facilitate robot-assisted therapy and the benefits and challenges of practical implementation of the robot. Clinicians who worked with stroke survivors to research the usability, feasibility, and efficacy of the Harmony exoskeleton discuss their impressions of the technology on stroke rehabilitation. Overall, therapists expressed positive views on the therapeutic and adjunctive use of robot-assisted technology, emphasizing patient engagement, objective evaluations of progress, and ease of certain aspects of their role. Additional feedback highlighted the Harmony exoskeleton’s ability to promote neuromuscular re-education and foster neuroplasticity. Barriers to implementation include physical capabilities, patient suitability, technical difficulties, and the need for advanced quantitative feedback and data analysis. To maximize the impact of robot-assisted therapy in stroke rehabilitation, ongoing research and development are necessary to address identified challenges. Improved limb support, quantitative feedback, equipment reliability, and more levels of weight support for patients with higher levels of function may improve therapist acceptance of this device and may inform exoskeleton development. READ ALL READ LESS Keywords Stroke, Rehabilitation, Exoskeleton, Robotics, Occupational Therapy Corresponding Author(s) Brittney Muir ( [email protected] ) Close Corresponding author: Brittney Muir Competing interests: No competing interests were disclosed. Grant information: This work was supported by a Department of Veterans Affairs, Puget Sound Health Care System Seed Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Muir B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Muir B, Teng T, Nagle-Chrsitensen A et al. Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.12688/f1000research.161900.1 ) First published: 21 Feb 2025, 14 :225 ( https://doi.org/10.12688/f1000research.161900.1 ) Latest published: 21 Feb 2025, 14 :225 ( https://doi.org/10.12688/f1000research.161900.1 ) Robot-assisted upper-limb therapy in research settings has shown improvements in upper limb function, muscle strength, independence in daily activities, and overall patient engagement and motivation ( Veerbeek et al., 2017 ). By providing consistent, measurable, and challenging exercises, robotic therapy enhances feedback and performance data while increasing the efficiency and frequency of therapy ( Mehrholz et al., 2018b ; Norouzi-Gheidari et al., 2012 ; Sivan et al., 2011 ). Clinicians generally have a positive attitude toward robot-assisted therapy; however, real-world implementation poses practical challenges, resulting in robotic tools being left unused. The purpose of this paper is to comment on robot-assisted stroke rehabilitation from the occupational therapist’s perspective. Feedback is provided by clinicians working with the Harmony Exoskeleton ( Figure 1 ) for acute post-stroke rehab. Figure 1. Harmony Exoskeleton can provide bilateral upper-body training in stroke survivors. Key features Range of motion to allow for functional movements Integrating functional movements into robot-assisted therapy is beneficial and motivational for patients ( Mehrholz et al., 2018a ; Veerbeek et al., 2017 ). Compared to previous upper extremity stroke rehabilitation robots, Harmony provides an extensive range of motion allowing clinicians to devise creative interventions and treatments. However, the Harmony Exoskeleton can still expand its capabilities to include dynamic movement at the wrist and grasping of the hands. The Harmony exoskeleton also requires the patient to be seated, limiting the robot’s use to seated activities. Limb support The use of robot-assisted technology is complementary to other forms of therapy and the use of graded limb support allows greater repetitions of treatments compared to manually supporting the patient’s limb ( Hamilton et al., 2019 ; Mashizume et al., 2021 ; Stephenson & Stephens, 2018 ). Due to the increased efficiency, the use of robot-assisted therapy can further promote neuromuscular re-education and foster neuroplasticity without concerns about the physical onus on therapists ( Turner et al., 2013 ). In contrast, we observed that Harmony could be limiting for patients who have progressed and no longer derive benefits from the support—phasing out the technology sooner than they might like. For example, one patient had reached the lowest support level offered by Harmony, however, without support, he still struggled to use his upper limb functionally. This suggests the need for further gradations to bridge the gap between the minimum support level and the complete lack of support. Measurable feedback Robot-assisted therapy allows for clear and measurable feedback on the patient’s progress, such as assistance levels used by the patient. This data could enhance clinician and patient understanding of changes on a session-to-session basis informing clinical decisions and improving patient communication of progress. The Harmony exoskeleton can also provide an objective assessment of motor activities and a comparison of the affected and unaffected sides enabling therapists to customize training according to individual needs. While we had positive responses to Harmony’s ability to provide quantitative data, we are interested in more advanced data about the quality of movements, range of motion, and mapping of the applied forces from the user. Ultimately, robot-assisted therapy is a promising way to document progress with tangible data, while saving time and informing interventions making them more efficient and effective. Identifying suitable clients Identifying suitable clients and windows of opportunity has been emphasized as a crucial factor in effectively implementing and regularly utilizing robot-assisted technology ( Flynn et al., 2019 ). The study team discussed the ideal conditions and user characteristics for the use of the Harmony exoskeleton including intact cognition, communication skills, activity tolerance, intact visual field, the ability to attend to the affected side, and some return in abilities, but not so much return that the robot becomes a constraint ( Figure 2 ). Figure 2. Clinicians discussed ideal user of the Harmony Exoskeleton. Technical difficulties and usability Like any technology, the Harmony exoskeleton occasionally experienced technical difficulties or malfunctions, which interrupted therapy sessions and caused frustration. We found the management of the robot challenging. This speaks to the need to increase comfort with the device, smoothing out the process overall, and developing a clinical-based interface. This finding aligns with the results of other studies that have examined clinician perspectives on the use of robot-assisted technology ( Chen & Bode, 2011 ; Flynn et al., 2019 ). Conclusion While the thoughts in this report center on the experience of using the Harmony Exoskeleton, these commentaries provide valuable insight to better inform robot design bridging the gap from research to implementation. Continued research and development of the Harmony exoskeleton and similar technology, incorporating the lessons learned from end-users, is necessary to maximize the potential of the technology’s impact on clinical care for stroke rehabilitation. Ethics and consent Ethical approval and consent were not required. Data availability statement No data are associated with this article. References Chen CC, Bode RK: Factors influencing therapists’ decision-making in the acceptance of new technology devices in stroke rehabilitation. Am. J. Phys. Med. Rehabil. 2011; 90 (5): 415–425. PubMed Abstract | Publisher Full Text Flynn N, Kuys S, Froude E, et al. : Introducing robotic upper limb training into routine clinical practice for stroke survivors: Perceptions of occupational therapists and physiotherapists. Aust. Occup. Ther. J. 2019; 66 (4): 530–538. 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PubMed Abstract | Publisher Full Text | Free Full Text Mehrholz J, Pohl M, Platz T, et al. : Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst. Rev. 2018b; 2018 . Publisher Full Text Norouzi-Gheidari N, Archambault PS, Fung J: Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. J. Rehabil. Res. Dev. 2012; 49 (4): 479–496. PubMed Abstract | Publisher Full Text Sivan M, O’Connor RJ, Makower S, et al. : Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. J. Rehabil. Med. 2011; 43 (3): 181–189. PubMed Abstract | Publisher Full Text Stephenson A, Stephens J: An exploration of physiotherapists’ experiences of robotic therapy in upper limb rehabilitation within a stroke rehabilitation centre. Disabil. Rehabil. Assist. Technol. 2018; 13 (3): 245–252. PubMed Abstract | Publisher Full Text Turner DL, Ramos-Murguialday A, Birbaumer N, et al. : Neurophysiology of Robot-Mediated Training and Therapy: A Perspective for Future Use in Clinical Populations. Front. Neurol. 2013; 4 . PubMed Abstract | Publisher Full Text | Free Full Text Veerbeek JM, Langbroek-Amersfoort AC, Van Wegen EEH, et al. : Effects of Robot-Assisted Therapy for the Upper Limb After Stroke. Neurorehabil. Neural Repair. 2017; 31 (2): 107–121. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 21 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Veterans Affairs, RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, 98144, USA 2 Department of Mechanical Engineering, University of Washington, Seattle, WA, 98144, USA 3 Department of Veterans Affairs, Rehabilitation Care Services, Seattle, WA, 98144, USA 4 Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, 98144, USA Brittney Muir Roles: Conceptualization, Data Curation, Funding Acquisition, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Tiffani Teng Roles: Data Curation, Writing – Original Draft Preparation Avocet Nagle-Chrsitensen Roles: Writing – Original Draft Preparation Abbey Lacey Roles: Data Curation, Writing – Review & Editing Claira Geller Roles: Data Curation, Writing – Review & Editing Matthew Stutzenberger Roles: Data Curation, Writing – Review & Editing Ileana Howard Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by a Department of Veterans Affairs, Puget Sound Health Care System Seed Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 21 Feb 2025, 14:225 https://doi.org/10.12688/f1000research.161900.1 Copyright © 2025 Muir B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Muir B, Teng T, Nagle-Chrsitensen A et al. Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.12688/f1000research.161900.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 21 Feb 2025 Views 0 Cite How to cite this report: Takhakh AM and Sarhan SM. Reviewer Report For: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.5256/f1000research.177993.r369348 ) The direct URL for this report is: https://f1000research.com/articles/14-225/v1#referee-response-369348 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Mar 2025 Ayad M. Takhakh , Al-Nahrain University, Baghdad, Iraq Saad M. Sarhan , Biomedical Engineering department, College of Engineering, Al-Nahrain University, Baghdad, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.177993.r369348 Comments : Title: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation The title is clear and accurately reflects the content of the manuscript. Abstract: ... Continue reading READ ALL Comments : Title: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation The title is clear and accurately reflects the content of the manuscript. Abstract: The abstract provides a concise overview of the study's purpose, methods, and key findings. It highlights the positive views of occupational therapists on robot-assisted therapy, particularly the Harmony exoskeleton, while also noting challenges such as technical difficulties and the need for further development. The abstract is well-structured and informative. Introduction: The introduction sets the stage by discussing the potential of robot-assisted therapy in stroke rehabilitation and the importance of therapist acceptance. It clearly states the purpose of the paper, which is to share occupational therapists' perspectives on the Harmony exoskeleton. The introduction is well-written and provides sufficient background information. Key Features: This section effectively outlines the key features of the Harmony exoskeleton, including its range of motion, limb support, and measurable feedback. The discussion on the limitations, such as the need for dynamic wrist movement and more gradations in limb support, is insightful and highlights areas for improvement. Identifying Suitable Clients: The criteria for identifying suitable clients for the Harmony exoskeleton are clearly presented. The emphasis on intact cognition, communication skills, and activity tolerance is relevant and practical. This section provides valuable guidance for clinicians considering the use of this technology. Technical Difficulties and Usability: The discussion on technical difficulties and usability challenges is important and aligns with findings from other studies. Conclusion: The conclusion succinctly summarizes the key points and emphasizes the need for continued research and development to maximize the potential of robot-assisted therapy in stroke rehabilitation. References: The references are relevant and support the content of the manuscript. They are appropriately cited and provide a good foundation for the discussion. Overall: The manuscript is well-written and provides valuable insights into the use of the Harmony exoskeleton from the perspective of occupational therapists. The structure is clear, and the content is informative. The manuscript would benefit from addressing potential biases and limitations more explicitly, but overall, it is a strong contribution to the field of stroke rehabilitation. Suggestions for Improvement: Expand on Limitations: Consider adding a section that explicitly discusses the limitations of the study, such as potential biases or the generalizability of the findings. Future Research: Include a brief discussion on future research directions to address the identified challenges and further validate the findings. User Interface Development: Emphasize the importance of developing a more intuitive and clinician-friendly interface for the Harmony exoskeleton to improve usability and adoption. Is the topic of the opinion article discussed accurately in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Yes Are arguments sufficiently supported by evidence from the published literature? Yes Are the conclusions drawn balanced and justified on the basis of the presented arguments? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Prosthetics and Orthotics We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Takhakh AM and Sarhan SM. Reviewer Report For: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.5256/f1000research.177993.r369348 ) The direct URL for this report is: https://f1000research.com/articles/14-225/v1#referee-response-369348 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 21 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 21 Feb 25 read Ayad M. Takhakh , Al-Nahrain University, Baghdad, Iraq Saad M. Sarhan , Al-Nahrain University, Baghdad, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Takhakh A et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Mar 2025 | for Version 1 Ayad M. Takhakh , Al-Nahrain University, Baghdad, Iraq Saad M. Sarhan , Biomedical Engineering department, College of Engineering, Al-Nahrain University, Baghdad, Iraq 0 Views copyright © 2025 Takhakh A et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Comments : Title: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation The title is clear and accurately reflects the content of the manuscript. Abstract: The abstract provides a concise overview of the study's purpose, methods, and key findings. It highlights the positive views of occupational therapists on robot-assisted therapy, particularly the Harmony exoskeleton, while also noting challenges such as technical difficulties and the need for further development. The abstract is well-structured and informative. Introduction: The introduction sets the stage by discussing the potential of robot-assisted therapy in stroke rehabilitation and the importance of therapist acceptance. It clearly states the purpose of the paper, which is to share occupational therapists' perspectives on the Harmony exoskeleton. The introduction is well-written and provides sufficient background information. Key Features: This section effectively outlines the key features of the Harmony exoskeleton, including its range of motion, limb support, and measurable feedback. The discussion on the limitations, such as the need for dynamic wrist movement and more gradations in limb support, is insightful and highlights areas for improvement. Identifying Suitable Clients: The criteria for identifying suitable clients for the Harmony exoskeleton are clearly presented. The emphasis on intact cognition, communication skills, and activity tolerance is relevant and practical. This section provides valuable guidance for clinicians considering the use of this technology. Technical Difficulties and Usability: The discussion on technical difficulties and usability challenges is important and aligns with findings from other studies. Conclusion: The conclusion succinctly summarizes the key points and emphasizes the need for continued research and development to maximize the potential of robot-assisted therapy in stroke rehabilitation. References: The references are relevant and support the content of the manuscript. They are appropriately cited and provide a good foundation for the discussion. Overall: The manuscript is well-written and provides valuable insights into the use of the Harmony exoskeleton from the perspective of occupational therapists. The structure is clear, and the content is informative. The manuscript would benefit from addressing potential biases and limitations more explicitly, but overall, it is a strong contribution to the field of stroke rehabilitation. Suggestions for Improvement: Expand on Limitations: Consider adding a section that explicitly discusses the limitations of the study, such as potential biases or the generalizability of the findings. Future Research: Include a brief discussion on future research directions to address the identified challenges and further validate the findings. User Interface Development: Emphasize the importance of developing a more intuitive and clinician-friendly interface for the Harmony exoskeleton to improve usability and adoption. Is the topic of the opinion article discussed accurately in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Yes Are arguments sufficiently supported by evidence from the published literature? Yes Are the conclusions drawn balanced and justified on the basis of the presented arguments? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Prosthetics and Orthotics We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (0) Takhakh AM and Sarhan SM. Peer Review Report For: Occupational therapists’ perspectives on the use of exoskeletons for post-stroke rehabilitation [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :225 ( https://doi.org/10.5256/f1000research.177993.r369348) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-225/v1#referee-response-369348 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });