The Importance of Participatory Design for the Development of Assistive Robotic Arms. Initial Approaches and Experiences in the Research Projects MobILe and DoF-Adaptiv

Abstract

This Article introduces two research projects towards assistive robotic arms for people with severe body impairments. Both projects aim to develop new control and interaction designs to promote accessibility and a better performance for people with functional losses in all four extremities, e.g. due to quadriplegic or multiple sclerosis. The project MobILe concentrates on using a robotic arm as drinking aid and controlling it with smart glasses, eye-tracking and augmented reality. A user oriented development process with participatory methods were pursued which brought new knowledge about the life and care situation of the future target group and the requirements a robotic drinking aid needs to meet. As a consequence the new project DoF-Adaptiv follows an even more participatory approach, including the future target group, their family and professional caregivers from the beginning into decision making and development processes within the project. DoF-Adaptiv aims to simplify the control modalities of assistive robotic arms to enhance the usability of the robotic arm for activities of daily living. To decide on exemplary activities, like eating or open a door, the future target group, their family and professional caregivers are included in the decision making process. Furthermore all relevant stakeholders will be included in the investigation of ethical, legal and social implications as well as the identification of potential risks. This article will show the importance of the participatory design for the development and research process in MobILe and DoF-Adaptiv.

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The Importance of Parcipatory Design for the Development of Assisve Roboc Arms.
Inial Approaches and Experiences in the Research Projects MobILe and DoF-Adapv
Annalies Baumeister, Elizaveta Gardo, Patrizia Tolle, Barbara Klein, Max Pascher,
Jens Gerken, Felix Goldau, Yashaswini Shivashankar, Udo Frese
DOI: 10.48718/8p7x-cw14
Abstract
This Arcle introduces two research projects towards assisve roboc arms for people with severe body im-
pairments. Both projects aim to develop new control and interacon designs to promote accessibility and a
beer performance for people with funconal losses in all four extremies, e.g. due to quadriplegic or mulple
sclerosis. The project MobILe concentrates on using a roboc arm as drinking aid and controlling it with smart
glasses, eye-tracking and augmented reality. A user oriented development process with parcipatory methods
were pursued which brought new knowledge about the life and care situaon of the future target group and
the requirements a roboc drinking aid needs to meet. As a consequence the new project DoF-Adapv follows
an even more parcipatory approach, including the future target group, their family and professional caregivers
from the beginning into decision making and development processes within the project. DoF-Adapv aims to
simplify the control modalies of assisve roboc arms to enhance the usability of the roboc arm for acvies
of daily living. To decide on exemplary acvies, like eang or open a door, the future target group, their family
and professional caregivers are included in the decision making process. Furthermore all relevant stakeholders
will be included in the invesgaon of ethical, legal and social implicaons as well as the idencaon of poten-
al risks. This arcle will show the importance of the parcipatory design for the development and research
process in MobILe and DoF-Adapv.
Keywords: Assisve robocs, Assisted Living Technologies, Parcipatory Design, Human-centered Design, User
Acceptance, Risk Management
Assisve Roboc Arms for a Self-determi-
ned Life
At the end of 2019, the German Federal Stascal
Oce counted 7.9 million people with disa-bilies.
Thereof 11.2% had funconal losses in arms and/
or legs and 10.4% in spine and torso. 7.6 million
people with severe disabilies lived in private hou-
seholds with their families, part-ners or alone (Sta-
ssches Bundesamt, 2020a + 2020b). As part of
the German Spinal Cord Injury Survey (GerSCI) in
2017, 1,479 people with spinal cord injuries were
quesoned about their life situaon, how they ex-
periences living with a spinal cord injury and what
kind of issues they were dealing with. Results to-
wards daily acvies and mobility showed that
running an own household was viewed as extreme-
ly problemac by 40.7% of the respondents. Rated
as very or extremely problemac were picking up
small objects or opening containers (31.2%) and
com-pleng everyday tasks (29.1%). Furthermore,
41% of the respondents said that they could open
heavy doors only with some or great dicules
and 18.3% were unable to open heavy doors at all.
The authors state that the descripve stascal re-

2
sults will be followed by qualitave studies and in-
depth analyses (Bökel et al., 2019, 22f.; 41).
Assisve roboc arms could be a soluon to ena-
ble people with severe body impairment to per-
form acvies of daily living independently. Cur-
rently, the online-Portal “rehadat-Hilfsmiel.de”
lists three assisve roboc arms on the German
market, JACO from Kinova inc., iArm from Assisve
Innovaons bv. and BATEO from EXXOMOVE UG.
All roboc arms are mounted on an electric wheel-
chair and steered with the wheelchair controller.
However, there are sll some challenges. In case of
funconal losses in hands and arms, steering with
a special controller is possible, but has its limits.
Operang a roboc arm with a chin or mouth con-
troller and thus eang or drinking, for example, are
mutually exclusive. Another diculty is the neces-
sity to constantly switch between dierent modes
of movement of the roboc arm, like up/down and
le/right, while performing a task.
The research projects MobILe and DoF-Adapv
presented in this arcle deal with new approaches
to the above-menoned challenges. Furthermo-
re, ethical, social and legal implicaons (ELSI) and
quesons of risk and quality management are in-
vesgated. In the spirit of Responsible Research
and Innovaon (see Owen, Slgoe et al., 2013), the
parcipaon of the future target group was or is
being pursued in both projects. Against this back-
drop, this arcle is intended to clarify the import-
ance of parcipatory approaches or parcipaon
in the research process and technology develop-
ment for research in the eld of assisve roboc
arms for people with severe physical limitaons.
Invesgang the Needs and Wishes of the
User in MobILe
How could it be feasible to control and use a semi-
autonomous roboc arm as a drinking aid, if using
a joysck is not an opon, due to funconal los-
ses in all four extremies? The aim of the MobILe
project was to research and implement basic skills
with and without direct physical contact between
robots and humans. For robot control in a three-
dimensional space, the use of head and eye move-
ments as well as a combinaon of moon sensors
and glasses with an eye tracker and electrooculo-
graphy was invesgated. For the interacon bet-
ween the robot and the human, augmented reality
Table 1: Fact sheet MobILe (authors gure)

3
(e.g., in the form of visual representaons of in-
tended acons by the robot) and a visual concept
were developed. A safety system with redundan-
cies ensures funconal reliability. To ensure that
the development of the control and interacon
modalies meet the future users’ needs and ac-
ceptance, a user-centred design strategy was im-
plemented throughout the research and develop-
ment process.
An Ethnographic/Small Data Analysis
At the beginning of the project an ethnographic/
small data analysis with 15 persons of the future
target group was conducted in Germany. Eleven
male and four females took part in the survey. The
diagnoses were spinal cord injury (10), locked-in-
syndrome (2), mulple sclerosis (1), inclusion body
myosis (1) and arthrogryposis (1). Parcipants
were visited at home, where in-terviews and par-
cipatory observaons of food and beverage intake
took place.
The observaons were documented with videos
and photos. The interviews and videos were tran-
scribed and the transcripts, videos and photos
were analysed following the qualitave content
analysis approach by Mayring (2015), the qualita-
ve hermeneucal approach from social sciences
by Reichertz & Englert (2011) and the photo ana-
lysis by Pilarczyk & Mietzner (2000). The aim was
to gain a deeper insight into the life situaon of
the parcipants in order to work out aspects that
promote acceptance and to develop user-centred
recommendaons for the technical development.
Demographic Data, Life and Care Situaon
The age of the parcipants varied between 18 and
62 years and was distributed relavely evenly. The
diagnoses or the accident events ranged from 2 to
35 years ago at the me of the survey. The only
excepon was in a case with congenital physical
impairment. Around two-thirds of the parcipants
have been living with a physical impairment for at
least ten years or longer. However, no signicant
dierences can be derived from the response be-
haviour in the interviews between parcipants
who have been living with their impairment for de-
cades and those who have obtained their physical
impairment more recently. Experiences with assis-
ve robots or technologies seem to be less depen-
dent on the duraon of the impairment than much
more on one‘s own interests or accessibility.
All parcipants stated that they are acve and like
to go out as much as possible. Some have con-
verted cars that the caregivers drive. Most of the
parcipants use an electric wheelchair (ten par-
cipants). Others prefer acve wheelchairs (three
parcipants) or use push wheelchairs (three par-
cipants). The parcipants live in accessible houses
(six parcipants) and in accessible or parally ac-
cessible apartments (nine parcipants). Seven par-
cipants live alone, three live with their parents,
three with a wife/husband or partner (in one case
with a child under 18 years) and one parcipant
lives with one child over 18 years. Caregiving rela-
ves exist in eight cases in which the parcipants
live with their relaves, whereby the extent of the
care provided varies. In seven of the eight cases,
nursing services take on certain aspects of nursing
(e.g., catheters or showers). In one case, assistants
also support the parcipant and his relaves. Par-
cipants who are not cared for by relaves oen
use both nursing services and assistants (ve par-
cipants). Only in two cases are parcipants suppor-
ted exclusively by a nursing service or assistants.
The daily structure is characterized by xed mes
of basic care (e.g., the morning toilet), relavely
xed/regular mealmes, regular therapies and
mes of relief (pressure ulcer prophylaxis). Most
of the me is spent in the bedroom (bed) and li-

4
ving room (wheelchair). The amount of me spent
in the wheelchair varies between 8 and 14 hours a
day. Parcipants said that they eat and drink in bed
or while sing in a wheelchair in the living room
or in the kitchen at a dining table. Drinking has a
special signicance, as both the type of beverage
(sll water, tea) and the amount consumed are
parcularly important for health and general well-
being. The parcipants oen drink large quanes
in a row and preferably from large glasses or drin-
king boles. For all parcipants, drinking is linked
to the aspects of autonomy and privacy. If they did
not have to ask for help for every sip, but could
drink independently, they would be able to spend
several hours a day alone again. Always having to
have someone around for assistance is perceived
as exhausng.
The Users Perspecve Towards an Assisve Robo-
c Arm as Drinking Aid
The analysis of the interviews and observaons
showed certain aspects that can inuence the ac-
ceptance and use of a roboc arm as a drinking
aid. Currently, the above menoned assisve ro-
boc arms can only be used while mounted on an
electric wheelchair. However, some parc-ipants
cannot or do not want to use an electric wheel-
chair. Parcipants would also like to use the robot
while lying in their bed and would prefer a soluon
that enables them to use the robot independently.
Most parcipants are cared for 24/7 by a mix of ca-
regiving relaves, nursing services and assistants,
which means, that dierent people are interacng
directly or indirectly with the robot. Therefore,
parcipants wish for an easy and intuive con-
trol and interacon design that does not require
too much explaining or a long training period. It
should also be safe to use, even if other people are
around and interacng with the parcipant. Furt-
hermore, the robot should be robust, sturdy and
show a high operang safety. Teething problems
or safety issues would prevent parcipants to use
the robot at all. How the roboc arm could be per-
ceived by others is important to most parcipants.
If it is too big and “showy” and/or looks too much
like a medical device, parcipants do not feel com-
fortable and fear sgmazaon. Instead, they
wish for an unobtrusive and elegant design, like a
lifestyle product and as space-saving as possible.
If the roboc arm promotes independency and
privacy, meaning that it enables the parcipants
to drink without addional help from others, the
parcipants stated that they would use it regularly
and would like to spend more me on their own.
On the other hand, parcipants would like to enjoy
mealmes with family and friends where everyone
can eat and drink at the same me and communi-
caon is not disturbed while someone takes care
of the parcipant. A roboc aid is seen as a possib-
le soluon as long as it is not the cause for new dis-
tracon. These ndings lead to recommendaons
for the development of roboc drinking and eang
aids, which are currently published at INTERACT
2021 (see Pascher/Baumeister 2021).
New Insights Through Including Caregivers
To discuss ethical and social implicaons of a robo-
c drinking aid, three workshops with all stakehol-
ders were conducted in 2019. A total of 11 people
with a disability, 2 caregiving parents, 4 assistants,
2 physiotherapists and 3 industry representaves
took part. In addion, all project partners joined
the rst workshop, too. The MEESTAR model for
the ethical evaluaon of socio-technological arran-
gements was adapted and used to evaluate ethical
issues. All workshops were transcribed and quali-
tavely analysed following the themac analysis
by Tucke (2005, 75.).

5
Caregiving parents and assistants brought a new
perspecve towards the topics safety and inde-
pendence. Both parcipang groups viewed an
assisve robot as posive if they feel assured that
the person they care for can be safely le alone
to perform a task with it. If the robot promotes a
higher independency, it would be a relief for ca-
regivers. Assistants could use their me more ef-
ciently and caregiving relaves would gain more
me for themselves. However, it also became clear
during the discussions that it is an issue to trust in
the safety of an assisve robot and leave the per-
son being cared for alone with it. Especially assis-
tants said that they don’t trust the robot and asked
what would happen, when a problem occurs? They
do not want to risk that the person being cared for
comes to any harm or that they cannot help them
(fast enough), if needed. Parcipants with a disabi-
lity, on the other hand, were much more inclined
to take risks, if only they could regain more privacy.
Whilst parcipants with a disability say that safety
standards in Germany are very high and they could
call the caregivers with a mobile phone if neces-
sary, the caregivers prefer them to be in another
room/close by and quickly available when needed.
So there is a profound conict of interest between
caregivers and the person being cared for about
gaining more privacy and autonomy.
Lesson Learned for Further Research
During the visits of the parcipants, some asked
why MobILe focused on drinking and how the de-
cision was made. Although drinking was viewed as
important, parcipants and caregivers menoned
further acvies a roboc arm could help with.
Parcipants mostly wished to pick up and manipu-
late objects or open doors. Again, in the context
of the workshops, people with a disability, parents
and assistants suggested more dierent acvies,
like support for dressing. It seems that people with
severe body impairments do have several unmet
needs that an assisve roboc arm could help with
and that it is important to include the future tar-
get group into the decision-making before deci-
ding what acvity the assisve roboc arm should
support. The inclusion of caregiving relaves and
assistants in the workshop made clear that it is
necessary to recognize the whole social system of
people with severe body impairments and to inclu-
de caregiving relaves, nurses and assistants into
the research project as well. The conclusion was to
pursue a more parcipatory approach in the suc-
cession project DoF-Adapv.
Table 2: Fact sheet DoF-Adapv (authors gure)

6
Including All Stakeholders in the Research and
Development Process of an Assisve Roboc
Arm
The ongoing research project DoF-Adapv aims to
simplify the use of assisve roboc arms, i.e. re-
leasing the users from the necessity to switch bet-
ween the various modes of degrees of freedom
while performing a task. A combinaon of machi-
ne learning and arcial intelligence (AI) will be
developed in order to improve the control system.
In contrast to automac control, humans remain in
control. In a user-centred design process, possibili-
es of displaying feedback are explored using data
glasses. In a parcipatory approach, the require-
ments are raised and the system is evaluated with
those aected.
Parcipave Research, Parcipatory Approaches
DoF-Adapv is conducted as research with peop-
le, rather than as research about or for them. This
course of acon is a characterisc feature of par-
cipatory research (Bergold/Thomas, 2010, 333).
The DoF-Adapv project is guided by fundamental
principles of parcipatory research. The following
secon focuses on two areas: the concept of „safe
space“ for all parcipants during the research pro-
cess and the roles of all parcipants in decision-
making processes (von Unger, 2014, 39.; Bergold/
Thomas, 2012, 6).
Parcipatory research can be understood as a re-
search style in which professional researchers and
co-researchers are equally involved in the pro-
cess of knowledge construcon (Bergold/Thomas,
2012, 2). In DoF-Adapv, two groups, the prima-
ry and secondary users of assisve technologies,
form the group of co-researchers. People with di-
sabilies (primary users), family caregivers, nurses,
assistants (secondary users) collecvely contribute
their unique perspecves. Expressing and sharing
their own opinions and experiences in instuonal
sengs or with strangers requires a “safe space“
(Bergold/Thomas, 2012, 5). The “safe space“ all-
ows, for example, to have and express dierent
opinions or to resolve conicts in a construcve
manner (Bergold/Thomas, 2012, 7). In addion, a
“safe space“ creates an opportunity for all mem-
bers of the research group to experience that each
opinion will be heard, but will not be judged or
even devalued by others. The “safe space“ is also
dynamic. It has to be reestablished over and over
again via opening communicave spaces throug-
hout the enre research process (Bergold/Thomas
2010, 338).
To determine whether a project fullls the basic
criterion for classicaon as parcipatory re-
search, it is necessary to ask who is controlling the
research in which phase of the project (Bergold/
Thomas, 2012a, 9). These quesons allow to de-
termine which group of researchers (professional
researcher or co-researcher) is involved in which
decisions, whether the various actors are involved
in decision-making-processes with equal rights
in order to control and monitor the research and
the course of the project (Bergold/Thomas, 2012,
10f.).
The research process in DoF-Adapv is designed
in cycles. These cycles are based on the process
of “Progressive Problem Solving with Acon Re-
search” (Riel quoted in Wright et al., 2013, 147).
Each cycle describes the reecng on pracce, the
acons taken, reecng and taking further acon
(Riel n.d.)
In the following, the concept of “safe space“ and
decision-making processes used to control and
monitor the research process at DoF-Adapv are
explained with a focus on the scenario develop-
ment.

7
Including the Future Users Early on
Based on the experiences in MobILe, the future
target group in DoF-Adapv includes not only peo-
ple with a disability, but their caregiving relaves,
nurses and assistants, too. Futhermore, the pro-
ject aims for a more parcipatory approach that
involves the future target group in the research
and development process from the beginning and
is iterave throughout the project. Starng with
the development of applicaon scenarios for the
assisve roboc arm, workshops and interviews
were held. It was decided which acvies the
roboc arm should support and which scenarios
should be described great importance was aa-
ched to the fact that parcipants and researchers
meet on an equal foong. Researches were in the
role of listening and documenng the parcipant’s
thoughts and wishes, accepng them as experts in
their own rights. Protocols, ndings and work-in-
process documents were shared with all parci-
pants throughout the development process. When
deciding on applicaon scenarios, the opinion of
the parcipants was decisive for the decision-ma-
king. Furthermore, parcipants were given the
opportunity to discuss the details of the scenarios
design with all researchers during a project mee-
ng. Those who couldn’t aend the meeng were
asked to give their view via e-mail or a one-to-one
call with a researcher, making sure that every par-
cipant who wanted to be part of the develop-
ment process and decision-making could parci-
pate. The transcripts, notes and protocols of the
workshops, interviews and the project meeng are
currently being analysed and the parcipave ap-
proach will be evaluated.
Impact of Parcipatory Approaches for Risk and
Quality Management
In the eld of medical technology, there is a sepa-
rate standard for managing risks. DIN EN ISO 14971
describes requirements and possible procedures
with a focus on risk analysis. Risks have to be iden-
ed and assessed to determine whether they are
jusable. Remaining residual risks must be set in
relaon to the benets. In 2019, a revision of the
risk management standard DIN EN ISO 14971 for
medical devices was published: ISO 14971: 2019.
The procedure has basically remained unchanged.
However, some addions and explanaons have
been introduced. Among other things, the infor-
maon for training opon was discussed as a risk
control measure. In addion, the concept of bene-
t for the paent was further specied. The stan-
dard has thus moved the issue of risk-benet rao
even more into focus. In the area of risk manage-
ment, the EU direcves and EU regulaons for
medical devices such as the MDR (Medical Device
Regulaon (MDR)) have to be taken into account
too. The risk analysis must factor in, inter alia, the
eects of soware errors, framework condions
and safety-relevant funcons.
As part of a project on „Systemic risk management
for the holisc consideraon of entrepreneurial
risks using the example of medical technology“ at
RWTH Aachen University, some weaknesses in the
current procedures and methods in the eld of risk
management in medical technology were discus-
sed and described (SysRisk). Among other things,
the current methods are seen insucient in scope
and depth to idenfy and assess residual risks as
comprehensively as is necessary for risk-sensive
products. In order to minimise these weak points
in the current project, risk management is being
expanded to include methods and procedures that
go beyond the mandatory standards and regula-
ons.
For this reason, the current project (DoF-Adapv)
puts a lot of emphasis on idenfying as many risks
as possible at an early stage and introducing ap-

8
propriate measures in a mely manner. The follo-
wing procedures and methods are used:
•Users are involved in the risk idencaon pro-
cess from the beginning of the project.
•FMEA (Failure Mode and Eect Analysis) is
used in the risk analysis to analyse the indivi-
dual components of the product, in parcular
the resulng hazards.
•The scenario technique or scenario-based risk
analysis is used for the invesgaon and eva-
lua-on of the inuencing factors and simula-
ted scenarios.
•Praccal conclusions for the intended area of
applicaon of the product are derived from
the acon-oriented error taxonomy. The ac-
on-oriented error taxonomy is based on an
error term that can be traced back to acon-
oriented error research (Freud, 1941, 25f.; Fre-
se, Zapf, 1991, 11f.).
Conclusions
The early involvement of the future target group
in the research project MobILe had a deep impact
on the further development of human-robot inter-
acon modalies. The insight into the life and care
situaon of people with severe body impairments
brought ndings towards aspects that promote a
higher acceptance of assisve roboc arms, all-
owed a user-centred development and new input
for further research was gained. In the ongoing
project DoF-Adapv, the inclusion of the future
target group into development and decision-ma-
king processes ensures that the research project
meets the future target group needs and will in-
crease their independence and autonomy in the
future. In this way, both projects seek to contribu-
te to a more independent living for people with
severe body impairments in the future.
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