This article was downloaded by: [Jathan Sadowski]
On: 27 May 2014, At: 06:29
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Responsible Innovation
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/tjri20
Exoskeletons in a disabilities context:
the need for social and ethical research
a
Jathan Sadowski
a
Consortium for Science, Policy & Outcomes, Arizona State
University, Interdisciplinary B Room 366, 1120 S Cady Mall,
Tempe, AZ 85287, USA
Accepted author version posted online: 19 May 2014.Published
online: 22 May 2014.
To cite this article: Jathan Sadowski (2014): Exoskeletons in a disabilities context: the need for
social and ethical research, Journal of Responsible Innovation, DOI: 10.1080/23299460.2014.918727
To link to this article: http://dx.doi.org/10.1080/23299460.2014.918727
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Responsible Innovation, 2014
http://dx.doi.org/10.1080/23299460.2014.918727
PERSPECTIVE
Exoskeletons in a disabilities context: the need for social and ethical research
Jathan Sadowski*
Consortium for Science, Policy & Outcomes, Arizona State University, Interdisciplinary B Room 366,
1120 S Cady Mall, Tempe, AZ 85287, USA
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
(Received 29 December 2013; accepted 23 April 2014)
The potential of exoskeletons – defined as powered, wearable robots that can enhance the user’s
strength and endurance – has many groups excited. While they receive some attention in
military-focused research, exoskeletons are also garnering attention in the civilian world, in
particular for people who have disabilities. This article describes some of the technical,
social, and ethical aspects of exoskeletons in a disabilities context. The paper’s main
purpose, though, will be to shine light on the dearth of social scientific and ethical analyses
of this subject and, in doing so, show that these technologies – which are quickly moving
from “emerging” to available – can no longer be overlooked as a subject of study.
Keywords: exoskeletons; disability technologies; politics of ableism; mobility
1. Introduction
The potential of exoskeletons – defined as powered, wearable robots that can enhance the user’s
strength and endurance – has many groups excited. It should not be surprising to find that militaries have staked an interest in developing exoskeletons for equipping their future soldiers. Such
machines could allow warfighters to carry heavy loads while still maintaining their mobility and
speed, as well as wield larger weapons and armor with greater ease.
In the popular imagination, exoskeletons are often thought of in (quasi-) military terms. Consider the blockbuster science fiction film Elysium (2013), which takes place in a dystopian world
with a stark divide between those who possess advanced technology and those who do not – a
divide so stark that the former group lives in a beautiful, luxurious space station, while the
latter live on a ravaged, dirty Earth. Central to the film’s plot is a high-tech exoskeleton surgically
grafted onto the main character that provides him with superhuman strength and endurance –
which he, of course, uses to kick ass in true Hollywood fashion. And, before Elysium, superheroes
like Iron Man have been tossing around cars and bad guys with their powered suits for decades.
Exoskeletons are, however, shaping up to have an impact in non-military contexts too. In the
civilian world, they can serve primarily as alternatives to traditional mobility-oriented assistive
technologies and can provide more possibilities – such as walking, climbing, and reaching –
than wheelchairs and crutches. They can be used as temporary rehabilitation equipment that
can, for example, support physical therapists in helping a person regain full or sufficient function
of bodily movements. Or, they can serve as a (semi-) permanent systems that can substitute for
parts of the user’s body disabled by severe illness or injury.
*Email: [email protected]
© 2014 Taylor & Francis
2
J. Sadowski
Engineers are making technical progress in exoskeletons and companies are beginning to
stake a claim in the emerging market. Yet, there remains a dearth of social scientific and
ethical analysis into these technologies. After gaining a technical foundation, this article will
raise tough questions about exoskeletal ethics and socio-politics. In doing so it will point to potential avenues of much needed research, which should occur before exoskeletons are widely incorporated into society.
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
2.
Overview of exoskeleton technology
Unlike stand-alone robots, exoskeletons are akin to a cyborg technology. They integrate with a
human to create a mechanical-organic system composed of complementary subsystems. For
instance, “for most people with neuromuscular diseases (NMD) and central nervous system injuries, muscle weakness is the primary cause of disability. In contrast, robotic manipulators can
perform tasks requiring large forces” (Rosen et al. 2005, 1). The exoskeleton’s movement
control algorithms, though, are not nearly as refined as the human mind’s ability to direct
bodily movement. Combining the robotic strength and endurance with human dexterity and
intelligence ostensibly creates a superior entity.
There are technical barriers to overcome before the optimistic visions of exoskeletons can be
fulfilled. For exoskeletons to be useful they must complement, rather than impede or constrain,
the human body’s natural kinematics – that is, the ways bodies move. Designing a functional
exoskeleton that can accommodate the range of degrees of freedom (DOF) human limbs have
– such as the seven DOF in the arm, all of which are needed to complete many common daily
activities – has proven to be a challenge (Rosen et al. 2005). As a paper in the Proceedings in
Applied Mathematics and Mechanics reports, progress on the kinematic structure of, specifically,
palm fingers exoskeletons has been slow going: “[I]n spite of over 40 years of exoskeletons
development most of the designs have a number of common drawbacks” (Tuliński and
Jasińska-Choromańska 2009, 176).
Lower limb exoskeletons may be easier to design, at least at first, because successful ones do
not require such a high level of DOF and nimble control. The RoboKneee, for example, is based
on an off-the-shelf knee brace that has a series of mechanical and robotic additions made to it
(Pratt et al. 2004). The RoboKnee only has one DOF – users can bend their knees such as
they do when walking or squatting – but this is enough to endow users with enhancements
while walking, climbing, carrying, and so on.
In the clearest demonstration, a user was able to do one-legged deep knee bends with a 60 kg backpack load filled with sand without getting tired. Without the assistance of the RoboKnee, the same
user could only do two to three one-legged knee bends with this weight, and on the order of 10
when using two legs. (Pratt et al. 2004, 2433)
An exoskeleton goes through a series of general, cyclical steps when it is providing mobility
assistance to the user: (1) The exoskeleton control system uses sensors, like ones that collect electromyography signals, to determine what position the user’s body is in. (2) When the user is ready
to move, the exoskeleton then uses those signals to determine the user’s intended action. (3) “The
control system selects a pre-programmed movement pattern, adjusts it to the user’s current position and supports the movement with actuators using the appropriate force” (Mikolajewska and
Mikolajewski 2011, 229). (4) Once the movement is complete, the exoskeleton analyzes the new
position and intentions, and makes new selections as needed.
There have been real advances in exoskeletons, specifically a handful of models focused on
the lower extremities. Consider the Berkeley Lower Extremity Exoskeleton (BLEEX),1 which
consists of “two powered anthropomorphic legs, a power unit, and a backpack-like frame on
which a variety of heavy loads can be mounted” (Kazerooni et al. 2005, 4364). BLEEX allows
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
Journal of Responsible Innovation
3
its users to carry heavy loads easily over any type of terrain where humans can walk – all while
maintaining a high level of DOF. BLEEX is primarily designed as an exoskeleton for people who
need to haul equipment or goods, such as “soldiers, disaster relief workers, wildfire fighters, and
other emergency personnel” (Kazerooni et al. 2005, 4364). However, as the first field-operational
exoskeleton, it served as a key stepping stone for other models and advances. Many of the
researchers in the lab that created BLEEX went on to found the company Ekso Bionics and
created the Ekso exoskeleton. According to the description on its website, Ekso “provides a
means for people with as much as complete paralysis, and minimal forearm strength, to stand
and walk … over ground with a natural, full weight bearing, reciprocal gait.”2 Ekso is currently
used in rehabilitation clinics, with plans to bring it to the consumer market in 2014.
Moreover, an exoskeleton created by the Japanese company Cyberdyne has just recently
passed German safety tests, “paving the way for the suit to be sold in other parts of Europe,
including the UK” (Woollaston 2013, http://www.dailymail.co.uk/sciencetech/article-2384930/
Robotic-exoskeleton-help-rehabilitate-disabled-people-passes-safety-tests–paving-way-sale-UK.
html). The machine is called the Hybrid Assisted Limb, or HAL – not quite a reassuring name if
one remembers the AI antagonist HAL 9000 from the film 2001: A Space Odyssey (1968). There
are two types of HAL systems that can assist users in performing everyday living activities. The
HAL 3 provides leg functions like walking, standing, climbing, deep knee bends, and so on, while
HAL 5 is a full-body exoskeleton that also includes arms and torso capabilities (Woollaston
2013). The HAL is different than many exoskeletons in how svelte, light, and aesthetically futuristic it looks.
3.
Exoskeletal ethics and socio-politics
A search for literature on the human and social dimensions of exoskeletons reveals a dearth of
work, a large gap that has hardly been looked into. Exoskeletons are often mentioned in
passing among other military technologies that could enter the battlefield. For example, a
recent report written by a group of technology ethicists and lawyers – Enhanced Warfighters:
Risk, Ethics, and Policy (Mehlman, Lin, and Abney 2013) – only mentions exoskeletons four
times, none of which are substantial. There is little empirical, social scientific data, for instance,
about the connection formed between the person and the exoskeleton: How do people use exoskeletons? How do others perceive exoskeletons? What type of agent is the human-exoskeleton?
How does personhood change with exoskeletons that are worn versus ones that are surgically integrated into the body? (Among many other questions.) Such a gap is an oversight for philosophers
and social scientists alike, especially because the technical trajectory indicates that exoskeletons
will soon be found “in the wild” and, perhaps in the near future, be widely used. If we are going to
understand how these technologies can be more responsibly designed and innovated, then their
ethics and socio-politics should be quickly spotlighted for analysis.
The lack of analysis is likely caused by a confluence of different factors, which are admittedly
speculative at this point. Exoskeletons are both new and emerging technologies, and have been
straddling that line in the realms of engineering and popular culture for at least 50 years (cf.
Cloud 1965). There is thus little buzz around them that might spark serious socio-ethical research.
The ramifications that near-future exoskeletons might have also seem like unalloyed goods: Soldiers and workers can carry heavy loads and disabled people gain more mobility – great! Exoskeletons have quite a technical jump to make before they become widely used and ethicists and
social scientists are simply compelled to examine them. As the authors of the above mentioned
report explain:
Exoskeletons today, then, are mere tools, as they are bulky and cannot be easily worn for a long stretch
of time; but if they were to become much more lightweight and unobtrusive, perhaps wearable like a
4
J. Sadowski
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
shirt, then a case could be made for declaring them an enhancement. (Mehlman, Lin, and Abney
2013, 13)
However, there is no reason to wait until that point; serious study should be conducted now,
while it is still relatively early and opportunities for social shaping and governance are easier to
implement (cf. Barben et al. 2008; Collingridge 1980).
Exoskeletons have also benefitted from a cascade of positive press coverage. For example,
when Ekso was revealed it caused quite a splash. In 2010, Wired Magazine and Time both put
Ekso on their list of top gadgets and innovations, respectively. In 2012, Inc. Magazine named
Ekso one the “5 Big Ideas for the Next 15 Years.” On Veteran’s Day 2013 (November 11),
Army pilot Gary Linfoot – who crushed his spine five years ago in a crash in Iraq – became the
first veteran to receive an Ekso, which will allow him to stand and walk again (Miller 2013).
And, on 17 November 2013, the largest gathering of users of ReWalk – another brand of exoskeleton that allows paraplegics and people with other disabilities to walk again – showed up in
New York City to participate in the Generosity 5 K, which raises money for the Bronx Veterans
Medical Research Foundation (Borgusky 2013). “The [ReWalk] suit is currently available only
in the Middle East and Europe,” said Larry Jasinski, the CEO of ARGO Medical Technologies,
the company that makes ReWalk (Borgusky 2013, http://www.foxnews.com/tech/2013/11/18/
exoskeleton-technology-helping-paralyzed-to-walk-again/). Jasinski says he “hopes to have
FDA approval to sell the suits in the United States for an approximate $65,000” (Borgusky
2013, http://www.foxnews.com/tech/2013/11/18/exoskeleton-technology-helping-paralyzed-towalk-again/).
This is not to say that such press coverage is unwarranted; it is clear that exoskeletons can do a
lot of good for people with disabilities. But, it is also clear why critical analysis is lacking: The
view that exoskeletons such as Ekso, BLEEX, or HAL are a step towards progress is even more
straightforward than many other technologies. After all, they grant new or restore old abilities to
users who were otherwise relying on wheelchairs, and with these abilities come other positive
health benefits that accrue due to standing and walking (Salisbury 2012). By restoring, at least
partially, a person’s ability to engage in daily life activities, exoskeletons present a more supportive and rehabilitative option than other current technologies.
But it is also not hard to imagine how an exoskeleton user could become dependent on a
device that provides so many capabilities. And with dependency also comes withdrawal, if
access to the device is somehow lost due to finances, cessation of a research study, military discharge, technical malfunctioning, or any number of reasons. These issues of dependency and
withdrawal should play into social scientific inquiries around exoskeletons. Similarly, there are
tough questions related to health insurance and the differences between categorizing the device
a “rehabilitative prosthesis” or an “enhancement.” The distinction between these categories is
not discrete, but exoskeletons can cause the boundaries to become even fuzzier.3
And even “less straightforward,” as sociologist Jenny Davis explains,
is the argument that Ekso [for instance] represents a step backwards, a move towards the further denigration of physically impaired bodies. Here we have a product made to improve the lives of those with
spinal cord injuries, and yet, it implies that walking, rather than wheeling, is necessarily the preferable
state of mobility. (2012, http://thesocietypages.org/cyborgology/2012/01/17/progress-versus-ableismthe-case-of-ekso/)
The Ekso is built to enhance and fix the “impaired” or “disabled” body, so that it fits into
societal conceptions of what it means to be “able-bodied.” Rather than changing the environment
or cultural definitions of “able” and “disabled” – both of which are dynamic over time – exoskeletons work within, and even enforce, structures of ableism and privilege. In this way, exoskeletons could be cast as inherently conservative technologies. The common normative “framing of
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
Journal of Responsible Innovation
5
enhancement as a matter of individual self-actualization, autonomy, and freedom of choice has
too often stifled the ability to give equal weight to the risks posed by dual-use, or by adoption
on a collective level” (de Saille 2014, 142). Exoskeletons ultimately raise questions about the
politics and ethics of ableism that deserve careful attention.
Over time, conceptions of disability have and will necessarily continue to change. Such
changes are to be expected as people gain new abilities and ways of living. Enhancement technologies, and the ideologies of transhumanism that accompany them in some contexts, will
fast-track this change: “Billions of people, who today are seen as able, will become disabled
not because their bodies have changed, but precisely because they have not changed their
bodies in accordance with the transhumanist norm” (Wolbring 2008, 254). However, we do
not have to wait for a transhumanist future to see how values and norms about what bodies are
supposed to look like and be able to do can influence real people making real choices. Technologies like exoskeletons are designed to fit people into the existing social and environmental structures of what is “normal,” and those who cannot afford exoskeletons remain disabled and
disempowered.
The point, of course, is not that exoskeletons should not be developed, and not that they are
inherently an ableist technology. Neither is it that people should not have choices about rehabilitation and restoration. The point is rather that while exoskeletons are being designed, and before
they are widely incorporated into society, the questions raised here (among others) should at least
be on the table and perhaps even tentatively, if not definitively, answered.
Put simply, any serious consideration – whether critique, condemnation, or support – of
enhancement technologies must also incorporate critical inquiry about ethics, politics, justice,
and social relations. Exoskeletons are likely to increase the quality of life for many people.
But they are expected to do so one machine at a time, for those who are privileged enough to
have access, and by reinforcing ideals about what it means to be normal and able – rather than
embracing a natural “variation of being” for humans. These are the types of critical avenues of
research that are missing in the largely technical literature on exoskeletons – and there are
many other lines of analysis and data waiting to be formulated and gathered. With a number of
different exoskeletons either available or scheduled to be on the market soon, social scientists
and ethicists have overlooked this technology, especially its non-military uses, for far too long.
Acknowledgements
Thanks to two anonymous reviewers for comments. And to Denise Baker, Josh Klein, Lisa Lacy, Clark
Miller, and Sara Hendren (@ablerism, who writes the Abler blog at Gizmodo), for helpful conversations
– both, directly and indirectly – about this paper. All views and mistakes are, of course, my own.
Notes
1.
2.
3.
For more information and images see: http://bleex.me.berkeley.edu/research/exoskeleton/bleex
Retrieved on November 25, 2013. http://eksobionics.com/ekso
I thank an anonymous reviewer for raising the issues of withdrawal and dependency, and the question of
health insurance.
Notes on contributor
Jathan Sadowski is a Ph.D. student in the Human and Social Dimensions of Science and Technology
program, which is in the Consortium for Science, Policy & Outcomes at Arizona State University. He is
also affiliated with the Center for Nanotechnology in Society at ASU. He has a masters degree in
Applied Ethics, and his research focuses on social justice and political economy of technologies. In addition
to scholarly publishing, he has written widely for a public audience in outlets such as The Atlantic, Slate,
Wired, and Al Jazeera America. (@jathansadowski).
6
J. Sadowski
Downloaded by [Jathan Sadowski] at 06:29 27 May 2014
References
Barben, D., E. Fisher, C. Selin, and D. Guston. 2008. “Anticipatory Governance of Nanotechnology:
Foresight, Engagement, and Integration.” In The Handbook of Science and Technology Studies,
edited by E. Hackett, O. Amsterdamska, M. Lynch, and J. Wajcman, 3rd ed., 979–1000. Cambridge,
MA: MIT Press.
Borgusky, S. 2013. “The Bionic Bunch: Largest Gathering Ever of Exoskeleton-wearers Walk for Charity.”
Fox News, November 18. Accessed November 25, 2013. http://www.foxnews.com/tech/2013/11/18/
exoskeleton-technology-helping-paralyzed-to-walk-again/
Cloud, W. 1965. “Machines That Let You Carry a Ton.” Popular Science, November.
Collingridge, D. 1980. The Social Control of Technology. New York: St. Martin’s Press.
Davis, J. 2012. “Progress Versus Ableism: The Case of Ekso.” Cyborgology, January 17. Accessed May 10,
2014. http://thesocietypages.org/cyborgology/2012/01/17/progress-versus-ableism-the-case-of-ekso/
Kazerooni, H., J.-L. Racine, L. Huang, and R. Steger. 2005. “On the Control of the Berkeley Lower
Extremity Exoskeleton (BLEEX).” Proceedings of the 2005 IEEE International Conference on
Robotics and Automation, Barcelona, Spain, 4364–4371.
Mehlman, M., P. Lin, and K. Abney. 2013. “Enhanced Warfighters: Risk, Ethics, and Policy.” Case Legal
Studies Research Paper No. 2013–2: 1–109. Accessed November 25, 2013. http://ssrn.com/abstract=
2202982 or http://dx.doi.org/10.2139/ssrn.2202982
Mikolajewska, E., and D. Mikolajewski. 2011. “Exoskeleton in Neurological Diseases – Current and
Potential Applications.” Advances in Clinical and Experimental Medicine 20 (2): 227–233.
Miller, J. R. 2013. “Paralyzed Army Veteran to Walk Again Using Exoskeleton.” Fox News, November 11.
Accessed November 25, 2013. http://www.foxnews.com/us/2013/11/11/paralyzed-army-veteran-towalk-again-using-exoskeleton/
Pratt, J. E., B. T. Krupp, C. J. Morse, and S. H. Collins. 2004. “The RoboKnee: An Exoskeleton for
Enhancing Strength and Endurance During Walking.” Proceedings of the 2004 IEEE International
Conference on Robotics & Automation, New Orleans, LA, 2430–2435.
Rosen, J., J. C. Perry, N. Manning, S. Burns, and B. Hannaford. 2005. “The Human Arm Kinematics and
Dynamics during Daily Activities – Toward a 7 DOF Upper Limb Powered Exoskeleton.”
International Conference on Advanced Robotics July, Seattle, WA.
de Saille, S. 2014. “Fixed: The Science/Fiction of Human Enhancement.” Journal of Responsible Innovation
1 (1): 142–145.
Salisbury, D. 2012. “Advanced Exoskeleton Promises more Independence for People with Paraplegia.”
Research News @ Vanderbilt, October 30. Accessed November 25, 2013. http://news.vanderbilt.edu/
2012/10/exoskeleton/
Tuliński, J., and D. Jasińska-Choromańska. 2009. “Design of the Exoskeleton as a Rehabilitation System.”
Proceedings in Applied Mathematics and Mechanics 9 (1): 175–176.
Wolbring, G. 2008. “The Politics of Ableism.” Development 51 (2): 252–258.
Woollaston, V. 2013. “Robotic Exoskeleton to Help Rehabilitate Disabled People Passes Safety Tests –
Paving the Way for it to Go on Sale in the UK.” Daily Mail Online, August 5. Accessed November
25, 2013. http://www.dailymail.co.uk/sciencetech/article-2384930/Robotic-exoskeleton-help-rehabilita
te-disabled-people-passes-safety-tests–paving-way-sale-UK.html