Participatory co-design of pediatric rehabilitation technologies: a practice-based perspective

Digital rehabilitation technologies are rapidly expanding across pediatric healthcare, yet many innovations fail to achieve sustained clinical adoption. In pediatric rehabilitation, this translation gap is amplified by heterogeneity in diagnoses and developmental stages, the need for family-centered care, and the practical constraints of clinical workflows. In this Perspective article, we argue that participatory co-design, an iterative process that actively involves clinicians, children, caregivers, and developers, incorporating stakeholder lived experience across the technology lifecycle, can reduce implementation failure and accelerate safe translation from concept to care. The purpose of this article is to present a structured, clinic-embedded participatory design framework spanning validated need identification, co-design, prototype testing, implementation support, and early-stage clinical validation. We illustrate this framework through two case examples from ALYN Pediatric & Adolescent Rehabilitation Hospital: 1. Headovations head support systems (Headaloft and the 360 multidirectional head support), and 2. the Pediatric Active-Passive Trainer (P-APT). Drawing on these experiences, we provide actionable recommendations for innovators, clinicians, and regulators regarding stakeholder engagement, usability and human factors evidence, documentation, and adoption metrics. We conclude that participatory co-design within pediatric rehabilitation hospitals represents a practical, regulatory-aligned pathway to foster technologies that are clinically meaningful, scalable, and sustainable in real-world care.