Currently, about 30,000 people with paralysis are candidates for exoskeletons, and the number is growing by about 18,000 every year. Increasing usage approvals for exoskeletons in the medical industry have encouraged companies to invest more toward research and development.
Wearable robots are helping people with paralysis walk again.
Over the last few years, there have been major developments in this field, giving hope to people with spinal cord injuries, neurological disorders and strokes. The use of these devices during rehab is growing and their benefits becoming more widely recognized.
The robots, such as ReWalk’s Exo-Suit, Ekso Bionic’s Ekso NR and Cybderyne’s Hybrid Assisted Limbs, can help even the most sedentary of all patients and improve their quality of life.
“It has been amazing to see how [the exoskeleton] affects a large group of people and not just the user,” said Larry Jasinski, the CEO of ReWalk. “We affect everyone around that individual—the spouse, the children, the friends are all engaged [when the patient] regains that mobility.”
Nearly 1 out of every 50 people in the U.S. live with some form of paralysis, approximately 5.4 million people, according to a 2013 study by Christopher & Dana Reeve Foundation. That figure is roughly equal to the combined populations of Los Angeles and Philadelphia. The number of people who are candidates for exoskeletons is about 300,000 and growing by about 18,000 every year, Jasinski said.
“I think the field of wearable robotics is at a very exciting time,” said Conor Walsh, a roboticist at Harvard University who works with ReWalk. “It’s been around for 20 years, but [in] the last five to 10 years there’s been an acceleration of research.”
According to the Exoskeleton Industry 2019 Global Market research report, increasing usage approvals for exoskeletons in the medical industry have encouraged companies to invest more toward research and development of exoskeletons across the world. Last year ReWalk received FDA clearance for Rewalk’s ReStore exosuit system, intended for use in the treatment of stroke survivors. ReStore is the only soft exosuit with FDA clearance.
ReWalk Personal 6.0 System is custom-designed for all day use at home and in the community. The precise fit optimizes safety, function and joint alignment.
A world of difference
Julio Caro was 22 when he fell 18 ft while working as a structural steelworker in southern California. He broke his back in two different places, injuring his spine and leaving him unable to walk.
“I was young, and so I didn’t understand what was happening,” Caro said. “They said, ‘You’re not going to be able to walk again,’ and I thought they were lying.”
“I just wanted to get back on my feet — I was out to prove everybody wrong,” he added. “So when I first heard [about ReWalk’s Exo-suit], I was, like, Robocop. As soon as I saw the machine and I saw it walk, I thought, ‘Oh cool, it does everything for you.'”
The ReWalk works like a marionette, connecting a cable from a patient’s waist to foot plates in their shoes, providing the appropriate assistance level needed to lift their toes. The bot is controlled through a wristwatch and reacts to sensors on the torso so it can sense when a patient tilts from one side to another, moving the feet accordingly, said Kathryn Vaugh, who is the director of product management for ReWalk.
After five sessions of physical therapy, Julio Caro was able to walk using the exoskeleton.
After five sessions of physical therapy — less than 20 hours total — Caro was walking again. He said he doesn’t often go out into public, because people stop him to ask questions and take pictures, but he said it’s made a world of difference in his life, allowing him to work on cars again and enjoy simple pleasures like reaching out to touch a leaf.
“I’m glad this technology is out there, [and] it’s only getting better,” he added.
Answering the call for stroke patients
Robotic technology has recently expanded to benefit stroke patients. More than 70% of people who suffer a stroke never regain their walking capacity, Walsh said.
Companies like Ekso and Cyberdyne are trying to change that.
Tuesday, Dec. 4, 2018, was supposed to be another normal day for Amelia Clark. The hairstylist dropped her three sons off at school and headed off to a hair-coloring class. She had a headache but passed it off as low blood sugar. Then she couldn’t stand up.
“I must have passed out, because when I woke up, I saw a whole bunch of lights and the doctor said, ‘Hi. What’s your name? You’ve had a stroke.'”
Clark was in the hospital for a month and a half, unable to walk unassisted. Then she was introduced to the Ekso NR. It was the first time she took a normal step since the stroke. Within three months she was able to walk with just a cane, and by August she started to drive again.
Amelia Clarke, 39, uses the EksoNR exoskeleton to learn how to walk again following a stroke, as part of her outpatient care at MidAmerica Rehabilitation Hospital in Overland Park, Kansas.
The Ekso NR is used by about 300 hospitals, according to Jack Peurach, the CEO of Ekso Bionics. But, in these cases, it’s not meant to be worn out of rehab centers. Instead, it helps train the brain and muscles, allowing patients with stroke, spinal cord injury or other neurological conditions, to retrain their bodies to walk.
In the case of a stroke patient, the goal is to teach them how to walk again so they don’t require a device for an extended period of time, Pejurach said.
Cyberdyne has a similar care model. Their exoskeleton, nicknamed HAL, is used at the Brooke Rehabilitation center in Jacksonville, Florida. This device operates based on the wearers intentions, whereas others work off of weight shift, said Amy Morace, the business and brand development manager at Brookes and Cyberdyne.
HAL, short for Hybrid Assisted Limbs, is a suit with small electrodes that attach to the leg muscles. The brain sends signals through the patient’s body and then electrodes pick up those signals and transmit them to the robot. The robot moves based on what those signals say to do. So when a patient thinks about moving forward, they can take a step forward, Morace added.
Insurance coverage still an issue
While robotics has made a huge difference in the lives of many, exoskeletons haven’t yet reached their potential, Walsh said. There have been great prototypes and many exciting demonstrations, he said, but “if you look around when you’re in the street or in hospitals, these devices are not getting used all the time, and the question is why.”
Cost is the biggest barrier for getting this technology to the millions of Americans who could benefit from it. Ideally, each robot should be customized to its wearer, which gets expensive, Walsh said.
“One of the reasons why the field hasn’t taken off is a lot of insurance companies still don’t cover these [exoskeletons],” Walsh said. “[We’re] building a body of evidence to be able to have insurance companies start to cover these so that people can access these technologies.”