While exoskeletons have been in existence for several years, it is only more recently the star as a rehab tool is rising. Usage among people with severe injuries has increased significantly, and the benefits they can bring to their lives are becoming more widely recognised.
The year ahead is seen as a potentially very significant period in the further development of the exoskeleton, with increasingly high-technology versions being developed, alongside those made for a home environment, rather than a traditional clinical setting.
Many sceptics still point to cost as being a prohibitive factor in the more mainstream use of exoskeletons, but ongoing medical trials are generating new levels of interest and attracting funding to aid research and development, which has led to hopes that costs may fall as a result.
Continual innovation is being seen in the development of the exoskeleton, with several companies from around the world leading the way in bringing new hope and possibilities to people living with conditions which vastly restrict or even prohibit independent movement.
ReWalk has devised a system which users can independently operate, and allows them to sit, stand, walk, turn and even gives the ability to climb and descend stairs. It was the first exoskeleton in the United States to receive FDA clearance to market, which has seen ReWalk leading from the front of the market as one of the early innovators in the field.
The company has a proven track record in its ReWalk being able to change the lives of people – earlier this year, 65-year-old former Army sergeant Terry Vereline, who is paralysed from the chest down, was able to use the robotic exoskeleton to complete the New York City Marathon.
She became the first person to use a high-tech walking device in a US marathon, and completed a reserved course in 26 hours over three days.
Similarly, Lucy Dodd, a British paraplegic, has spent the last 14 years in a wheelchair after being struck down by a rare spinal condition aged just 18. She is now another successful ReWalk case study, using the technology to regain independent movement.
The Ekso range is, according to the company, the only exoskeleton devised by clinicians for clinicians, and its EksoGT powered hip-knee model is in use around the world having become the first exoskeleton to be approved by the FDA for people recovering from a stroke, and is also approved for use by spinal cord patients.
The company recently unveiled its next generation model, the EksoNR, developed for neurorehabilitation purposes. The intuitive skeleton helps patients recovering from stroke or other conditions to walk again with a more natural gait, and features a number of software enhancements and technology-led solutions to lead the Ekso into the future.
EksoNR is equipped with EksoView, a new touchscreen controller that lets therapists intuitively adapt assistance to challenge patients by using real-time feedback, and perform outcome measures during use. The EksoView gives visualisation of exercises beyond gait training, including balancing, squatting from a sit-to-stand position, lifting one leg, or standing in place.
The EksoNR builds on the success of the EksoGT, which is used in hundreds of rehabilitation centres around the world and is recognised for its proven efficacy in patients re-learning to correctly stand and walk after a stroke.
One of the earliest names in this field – having been established in 2004 to share the research of Professor Yoshiyuki Sankai, of the University of Tsukuba – Cyberdyne is behind the development of the world’s first cyborg-type robot, HAL.
A world-leader in exoskeleton development, HAL – which stands for Hybrid Assistive Limb – claims to be a fusion of man, machine and information, through its method of helping a person with limited mobility to achieve movement. As a result of years of trials, HAL can read the bio-electric signals from within a person’s body communicating the desire to move, and can assist the joint’s movement in conjunction with the person.
Its example of Philippe von Gliszynski, paralysed after falling through a roof, is a real-life articulation of the impact HAL can have. Having been told to prepare for a lifetime of wheelchair use, Philippe took part in research trials for functional improvement with HAL, which culminated in him being able to walk 10 metres in only 26 seconds. He then went on to walk more than 1,000 metres with a walker without assistance from HAL, showing the lasting benefits its use can have.
The company, a global leader in motion and control technologies, is pioneering the next-generation Indigo Therapy exoskeleton, for use in rehabilitation centres. Its model can be custom sized and fitted to patients for bespoke use.
Its Therapy+ software suite, included with each Indego Therapy device, incorporates control algorithms based on motor learning principles and allows for an individualised, patient-centric training approach where the device responds to a patient’s active contribution and assists in gait only when necessary.
Therapists also have a range of customisable settings within the Therapy+ software suite which allow them to further tailor the system to specific impairment and gait needs.
Parker’s use of custom tailoring therapy devices is a new addition to the clinical offering to patients suffering from the effects of spinal cord injuries and stroke.
The company is also tackling the issue of cost of exoskeletons by offering bespoke therapy sessions to patients at a significantly lower price point, in a new approach which is seen as helping to open up the market.
REX, based in New Zealand and Australia, has brought its exoskeleton to market which offers a wide range of accompanying ‘REXercises’ which are specifically designed for patients with mobility impairments and provides patients with safe and effective movements.
The REX model is hailed as being particularly easy to use, with patients being shown to gain autonomous control of the device even in their first session. It is also adjustable to a person’s measurements within minutes, enabling a high turnover of patients to use it in a clinic.
The business also has the REX P model, which is designed for home use, rather than in a clinical environment. It does not require the use of crutches, giving the user the freedom to use their hands while remaining stable and balanced.
In a further breakthrough for home-based exoskeleton use, REX P also has rehabilitation exercise opportunities for users in their home, including standing, walking, stretching, weight bearing.
Hocoma is the pioneer of the world’s first exoskeleton for integrated arm and hand rehabilitation, which trains even severely affected stroke patients to use their arms and hands again.
The business, a global leader in robotic and sensor-based devices, launched ArmeoPower in 2015, and it has since been successfully piloted in many of the most innovative hospitals in the United States and Europe, with the device being integrated into clinical routines across both continents.
ArmeoPower has broken new ground in using technology to support the movement chain from the shoulder to the fingers, and adds to the company’s wider Armeo Therapy Concept. This includes four distinct products for upper extremity neurological rehabilitation, which cover all stages of the recovery process, from the most severely affected early-stage patients to long-term rehabilitation in the outpatient settings.
Helping to pave the way for the future of exoskeletons is Honda, whose Walking Assist Device, a partial exoskeleton to help those with difficulties moving unsupported, has been given premarket notification within the United States, following successful clinical trials.
The robotic device has been in research by Honda since 1999, with the company exploring bipedal robotic movements and their potential for human support. That research helped develop ASIMO, Honda’s humanoid robot, but continued in parallel with the exoskeleton.
Rather than restore walking abilities to people who have completely lost the use of their legs, the Walking Assist Device instead aims to help those with gait deficits.
Honda’s exoskeleton straps onto the waist and around the legs. Sensors in the right and left sides track the position of the user’s hip joints, while motors in the leg sections help promote symmetrical walking patterns, as well as generally guiding movement. At the same time, progress of metrics like left-right symmetry, movable hip angle range, walking speed, and other gait parameters are logged and can be analysed.
The company has developed an array of exoskeleton solutions for rehabilitation and clinical use, but it is its current pioneering development which is seen as reaching new levels of innovation.
In a first for the sector, Bionik Labs is incorporating the use of Amazon Alexa integration into its ARKE exoskeleton, which will allow wearers to issue hands-free voice commands to control their movement.
The adoption of Alexa is to support the challenges of the daily routine for people living with the affects of conditions like stroke or paraplegia, and the use of voice-controlled technology can replace, to some extent, the need for help from a third party. Alexa can even help keep track of the battery usage and capacity of the exoskeleton itself.
While this much-anticipated exoskeleton is still in the prototype stage, the company has reported that development is progressing well, with Bionik Labs even releasing a video showing the ARKE exoskeleton in use with an Amazon Echo.