PROJECT SUMMARY/ABSTRACT Lack of exercise is a major cause of secondary health conditions, especially for people with paralysis, for whom participation in physical activity is especially difficult. Hybrid functional electrical stimulation (H- FES) exercise enables vigorous, total body physical activity for people with paralysis. However, existing H-FES devices are neither affordable nor accessible, preventing widespread distribution of their benefits. A new H-FES device is critically needed to promote widespread, sustainable physical activity outcomes in the homes and communities of people with paralysis. Thus, the overall objective of this Phase I STTR is to transfer the success of a particularly effective form of H-FES exercise, FES-assisted indoor rowing, from the Spaulding Rehab ExPD Program to the homes of people with paralysis. The rationale underlying this objective is that limited motor function, inaccessibility, and fewer opportunities to vigorously exercise increase morbidity and mortality for people with paralysis, so a novel device that effectively addresses these issues can reduce healthcare costs and improve both quantity and quality of life despite paralysis. Successful completion of the following specific aims will accomplish the overall objective and demon- strate the commercial feasibility of in-home FES-rowing: 1) discover and specify the user needs related to FES-rowing at home, 2) modify an existing FES-rowing prototype based on unmet user needs, and 3) validate that the new design meets home user needs. Aim 1 will be accomplished by surveying and observing prospective customers, especially current participants in FES-rowing, regarding physical ac- tivity and FES-rowing. The responses and observations will then be translated into technical design re- quirements for the new FES-rowing system. Aim 2 will be accomplished by analyzing Spaulding’s existing FES-rowing prototype to identify unmet design requirements, modifying the system to satisfy unmet de- sign requirements, and building a next-generation prototype that incorporates the design modifications. Finally, Aim 3 will be accomplished by validation of the new prototype with the participants from Aim 1. The scientific premise of this project is that FES-rowing is the most appropriate and effective exercise intervention for improving aerobic capacity in people with paralysis, which is strongly linked to the pre- vention of secondary conditions. Thus, the development of an FES-rowing system suitable for commer- cialization is significant because it could provide the general population of people with paralysis an ac- cessible and effective means for preventing secondary conditions through vigorous, total body exercise. Such effort is innovative because it represents a substantive departure from the status quo by making H- FES exercise affordable and accessible, presenting new horizons for exercise-based preventive healthcare for people with paralysis.