It is recognised that assistive technology plays an active role in empowering individuals who live with severe paralysis. Exoskeleton (exo) technology is a promising emerging assistive technology—a wearable robot designed to support the functions of the human body. However, an exoskeleton is a complex technology, and the successful design of exoskeletons depends heavily on the ability to integrate this type of robot in the environments of future users. In this paper, we present insights into user requirements produced through a qualitative study involving adults living with one of the most severe forms of paralysis: tetraplegia, or paralysis from the neck down. The study is based on two iterations of interviews conducted in the homes of future users. The study identifies key user requirements and contextual factors that are important for user acceptance of future exo design. We discuss how to integrate these findings in the design of an exo prototype of an exoskeleton arm targeted at people living with tetraplegia.