Robotic Exoskeletons for Physical Rehabilitation

Paraplegia is a condition of the lower extremities that is characterized by sensory and motor impairments. It is caused either by a congenital defect such as spina bifida or, more commonly, a spinal cord injury to the lumbar, thoracic or sacral region. The U.S. National Spinal Cord Injury Statistical Center (NSCISC), a government-funded and -managed injury database, estimates that more than 275,000 Americans suffer severe spinal cord injuries each year. Nearly 52% of these patients develop paraplegia. 

Wheelchairs Don’t Go the Distance

Wheelchairs remain the clinical gold standard for regaining mobility: They are indispensable to nearly 150 million users globally. While today’s best-in-class, motorized wheelchairs offer paraplegics the kind of lifestyle that was inconceivable a few decades ago, there are still limitations. 

• Because the user is in a seated position for extended periods of time, secondary complications such as muscle spasticity, chronic pain and gradual muscle degeneration are often observed. Clinical literature from organizations such as the NSCISC and the Christopher and Dana Reeve Foundation identify urinary tract infection, pressure sores, deep vein thrombosis, respiratory infection and digestive problems as long-term concerns. 
• Despite efforts from the federal government (through the Americans with Disabilities Act) and the community, not all public places are wheelchair-accessible. There are a number of reasons for this, ranging from lack of awareness to difficulty in enacting infrastructural changes and poor city planning, all contributing to the social exclusion of people with physical disabilities. 
• A dependence on wheelchairs often has negative effects. The World Health Organization reports that nearly 30% of people with spinal cord injuries show signs of clinical depression, which affects recovery and well-being.

Exoskeletons Take Powerful Strides in Physical Rehabilitation

The health care industry has adapted robotic exoskeletons, which were originally designed for heavy lifting in factories, into tools for physical rehabilitation. A robotic exoskeleton suit is made functional by a combination of motors, actuators, and electromechanical and hydraulic systems, all powered by an on-board battery and a computer system designed to mimic the natural gait of the wearer. 

The research and commercial interest in robotic exoskeletons is apparent from the crowded marketplace—a combination of industry veterans such as Hyundai, Honda and Panasonic, and enthusiastic young university spin-offs such as Indego (originally developed at Vanderbilt University) and suitX (also known as US Bionics, and spun off from the University of California at Berkeley). Some of the most successful robotic exoskeleton companies are profiled below.

Ekso Bionics

EksoGT is a wearable suit developed exclusively for use in clinical settings and rehabilitation centers. This tool helps stroke patients and people with spinal cord injuries regain their mobility sooner, giving them computer guidance to regain a proper gait. It is used under the guidance of trained personnel in more than 160 rehabilitation centers globally. 

The company also designed the EksoZeroG and EksoVest suits for physically demanding jobs, such as on construction sites. These are mostly upper-body suits that reduce the stress and wear and tear on burden-carrying joints. 

Rex Bionics

New Zealand-based Rex Bionics has two products: REX Personal for home use and REX Rehab for assisted-physiotherapy and rehabilitation. These are essentially half-suits—almost pants-like in their appearance—but they are unique in that a user walks into one. This, in a way, removes the burden on a patient’s upper body; instead, the patient easily controls feet movement using joystick controls at the hip level. REX products are CE marked and available in Europe and other countries where the mark is recognized. The products are not registered with the U.S. Food and Drug Administration (FDA) and are not available for sale in the United States.

ReWalk Robotics

Israel-based ReWalk Robotics (formerly Argo Medical), was one of the earliest rehabilitation robot companies in the market. ReWalk’s eponymous suit received clearance from the FDA—the first such regulatory approval—for use outside a clinic setting. The ReWalk platform is made of lightweight composite materials and is powered by a battery that runs motors at the hip and knee joints. ReWalk offers the platform for at-home use (ReWalk Personal 6.0) or as a rehabilitation tool in clinics (ReWalk Rehabilitation).

In June 2017, ReWalk unveiled the prototype of its latest lightweight suit, developed specifically for patients with mobility issues due to stroke or multiple sclerosis. Developed in partnership with the Wyss Institute for Biologically Inspired Engineering at Harvard University, the suit is undergoing clinical trials and is expected to be market-ready by 2018.

Affordability: Light on the Horizon

Robotic exoskeletons have established themselves as a technology that can provide mobility and independence—both physical and psychological—to millions of people. Adapting an old adage, having now learned to walk, the technology must now get ready to run. Frost & Sullivan believes that the next hurdle to leap is cost. 

One of the complaints about most commercially available robotic suits is the price tag: A made-to-order exoskeleton suit for personal use costs upwards of $80,000. According the Reeve Foundation, nearly 28% of all Americans living with paralysis survive on an annual household income of less than $15,000. That most suits are not covered by health insurance keeps this remarkable technology beyond many people’s reach. SuitX already is confronting this challenge: By reducing the weight of its Phoenix suit (just 27 pounds compared with others that weigh more than 50 pounds) and opting for a modular design, the company has lowered its price to $44,000. 

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