Considerations Regarding Exoskeleton Use for Mom

## Written with love, curiosity, and a desire to support Mom in the best way possible

Before anything else, I want to say this:

The fact that we are even having this conversation says something important.

It says that we love Mom.

It says we care deeply about her quality of life, her movement, her health, and her future. It says we are not giving up on her. It says we are looking for ways to help.

That matters.

Sometimes when someone we love is struggling—especially when there are cognitive changes and we feel limited in what we can do—the feeling of helplessness can become enormous. It can create a very understandable urge:

*"We have to do something."*

And that desire comes from love.

So this report is not meant to criticize the idea of an exoskeleton or say anyone's thinking is wrong. The goal is simply to slow down, look carefully, and make the best decision possible before making a large investment.

---

# Current Question

Should we invest in an exoskeleton to help Mom walk more?

At this point, my opinion is:

**Possibly someday. Probably not yet.**

Not because I think movement is unimportant.

Not because I think technology is bad.

But because I think there may be deeper questions we should answer first.

---

# Observation #1:

## Strength alone may not be the limiting factor

Mom appears to still have physical capability and strength available.

Yet she often does not want to participate in certain activities.

That raises an important question:

Is the issue truly weakness?

Or is something else making movement feel difficult, overwhelming, confusing, or unsafe?

In my own clinical experience, and from what I experienced helping Tony, when someone avoids an activity they are physically capable of doing, there is often a reason beneath the behavior.

Sometimes that reason is:

- fear

- confusion

- overwhelm

- uncertainty

- discomfort

- loss of confidence

- fatigue

- feeling unsafe

- inability to process the situation

With dementia, it can become very difficult to identify exactly what that reason is.

The challenge is that cognition can limit communication.

She may not be able to explain what she is feeling.

But inability to explain something does not mean nothing is there.

---

# My Personal Clinical Observation

This is my opinion and personal observation:

One of the biggest lessons I learned helping Tony was that safety mattered enormously.

Not safety as an idea.

Not mentally convincing someone.

But helping the body experience support, familiarity, comfort, ease, and safety through actual experiences.

I repeatedly saw that when safe signals increased, participation often improved.

I am not saying Mom's situation is identical.

I am saying I think this possibility deserves investigation before assuming that movement refusal equals weakness.

When I visit, I would like to gently explore whether she responds to simple experiences that may increase comfort and safety.

Examples:

- familiar touch

- familiar rhythms

- gentle movement

- reducing pressure

- simple sensory cues

- enjoyable activities

- creating calm environments

- reducing overwhelm

If we notice meaningful changes, that may tell us something important.

It would also provide ideas that you all could continue using.

---

# Observation #2:

## Exoskeletons may begin with disadvantages in this situation

Exoskeleton technology is impressive.

Research shows promise in areas such as:

- stroke rehabilitation

- spinal cord injury

- gait retraining

- neurological rehabilitation

But these devices were generally not designed specifically for:

- adults in their 80s

- dementia

- significant cognitive impairment

- movement avoidance related to cognitive or emotional factors

That matters.

Because these systems often require:

- understanding instructions

- tolerating equipment

- adapting to movement timing

- participating in structured tasks

If the underlying barrier is confusion, uncertainty, or feeling unsafe, a complex device could unintentionally increase those feelings.

Again:

That does not mean it cannot help.

It means we should be careful about assuming it will.

---

# Observation #3:

## Every intervention has benefits and risks

Even simple tools require appropriate use.

A hot water bottle can help.

A hot water bottle can also burn skin.

A walker can help.

A walker can also become frustrating if someone cannot use it safely.

An exoskeleton is no different.

It is not automatically good or bad.

Its success depends on:

- appropriate match

- timing

- supervision

- tolerance

- participation

- cognitive ability

Right now I am uncertain whether we know enough to say this is the right level for Mom.

---

# A Real Concern That I Believe Matters

I understand one of the fears underneath this conversation.

If Mom moves less:

Will she become weaker?

Will she become more vulnerable?

Will illness become more likely?

These concerns are absolutely valid.

Movement matters.

Circulation matters.

Strength matters.

Engagement matters.

No one should minimize those concerns.

---

# Something I Do Not Want Us To Underestimate

I want to say something directly.

Dad, your presence matters.

Kim, your presence matters. 

Your affection matters.

Your patience matters.

Your consistency matters.

Your joy matters.

Your love matters.

Those things are not "nothing."

Those things are enormous.

Sometimes when caring for someone we love, especially with dementia, it can feel like we are not doing enough because we cannot fix the problem.

But connection itself may be one of the most therapeutic things available.

Mom may not understand what you’re saying, maybe she can a little,

but emotional experiences and feelings often remain deeply meaningful.

Please do not underestimate what you are already giving her.

---

# My Current Recommendation

Rather than immediately investing in an exoskeleton:

Step 1:

Observe and explore.

When I visit:

- experiment gently

- watch responses

- reduce pressure

- create comfortable experiences

- see what helps participation emerge naturally

Step 2:

If we see signs of increased engagement or willingness:

teach and continue those approaches.

Step 3:

If movement remains difficult and concerns continue:

consider professional trials, demonstrations, or supervised experiences before purchasing equipment.

Trial first.

Purchase second.

---

# Final Thought

I do not think this situation is hopeless.

I also do not think there is "nothing we can do."

I think there may be things we have not discovered yet.

And before investing in technology, I think Mom herself may still teach us something important if we pay attention carefully enough.

Let's stay curious.

Let's stay open.

And let's keep helping her together.

James

**My words but chat helped me organize into a report (he did a good job actually)