Saskia Baltrusch

16 Chapter 1 used to perform benchmark testing of an exoskeleton that is commercially available (Laevo). This benchmark test allows to assess drawbacks and benefits of current lifting devices and formulate design improvements to be considered in the SPEXOR exoskeleton. Specifically, in Chapter 3 , I assessed functional performance and user satisfaction when performing a wide variety work-related tasks with this Laevo exoskeleton. Outcomes, such as comfort, perceived difficulty and freedom of movement were investigated to detect potential benefits and limitations. In Chapter 4 , I focused on the aerobic loading to investigate how the Laevo exoskeleton affects movement efficiency. Subsequently, the benchmarking tests were repeated with the prototype SPEXOR exoskeleton to assess potential achieved improvements with this novel device and to formulate aims for further design adaptations. The design of the SPEXOR exoskeleton is described in Chapter 5, which also explains the design requirements and considerations that are implemented in this system. Additionally, single component testing, biomechanical and functional pilot tests present first results of the new design in this chapter. Chapter 6 focuses on the effect of the SPEXOR device on functional performance and user satisfaction. In Chapter 7, I addressed aerobic loading again, by measuring metabolic cost during lifting and explain changes in aerobic loading by measuring muscle activity and mechanical joint work. The last part of my thesis focuses on the challenge to implement the SPEXOR exoskeleton in the work environment. Using a mixed method approach, Chapter 8 addresses how the SPEXOR exoskeleton could influence self-efficacy and acceptability by potential end-users. A focus group with potential end-users and an interview with decision makers add insight into design improvements and recommendations for implementation strategies. In Chapter 9 (the general discussion), I summarize and discuss the results of the different studies described in this thesis and discuss the implications of the findings of this thesis for future research, clinical practice and the work field.