Exoskeleton Use for Persons
following a Traumatic Injury
Casey Kandilakis, PT, DPT, NCS
Learning Objectives
Following this presentation, attendees will be able to:
1. Discuss (1) what an exoskeleton is, (2) how exoskeletons
work, and (3) why they are so popular in neurological
rehabilitation now.
2. Give examples of who would be a good candidate for an
exoskeleton.
3. Discuss the goals of and potential barriers to
incorporating an exoskeleton into the continuum of care
for individuals following a traumatic injury.
Disclosure Statement
• Faculty/Presenters/Authors/Content
Reviewers/Planners disclose no conflict of
interest relative to this educational activity.
• The presenter’s employer, Shepherd Center, is
a clinical partner of Parker Hannifin,
manufacturer of Indego.
Successful Completion
• To successfully complete this course, participants
must attend the entire event and complete/submit
the evaluation at the end of the session.
• Society of Trauma Nurses is accredited as a provider
of continuing nursing education by the American
Nurses Credentialing Center's Commission on
Accreditation.
Recent Advances in Technology
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Recent Advances in Technology
• Smartphones were enabled by several
advances in technology:
– Improved electronic circuits,
microprocessors, and microcontrollers
– Advances in battery capacity
– Advances in software, development
platforms, and development tools
– Advances in wireless technologies
(BlueTooth, WiFi, etc)
– THE INTERNET
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Recent Advances in Technology
• Robotics have benefitted from the same advances as the
smartphone (in addition to several others).
• These advances have given us opportunities we may never
have thought possible!
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So What is an Exoskeleton?
• A powered exoskeleton is a mobile machine consisting primarily of
an outer framework (akin to an insect's exoskeleton) worn by a
person, and powered by a system of motors or hydraulics that
delivers at least part of the energy for limb movement (Wikipedia)
• An exoskeleton is an artificial external supporting structure
(Merriam-Webster)
• Exoskeletons are wearable robotic suits that allow people with
lower-body paralysis to walk upright again (CNN)
So What is an Exoskeleton?
4 Primary Exoskeletons in
Healthcare / Rehabilitation
Categories of Rehabilitation Technology:
Where do Exoskeletons Fit?
Assistive
Devices
Exoskeletons?
Therapeutic
Devices
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Potential Benefits of Exoskeletons?
MUCH more research is needed on these technologies, but these are several hypotheses
• As a Therapeutic Device:
– Improved neurological and functional recovery
– Decreased secondary complications
– Improved upright tolerance
Potential Benefits of Exoskeletons?
MUCH more research is needed on these technologies, but these are several hypotheses
• As an Assistive Device:
– Continued neurological and functional recovery beyond traditional therapy
services
– Improved participation (at home, in the community, and in the workplace)
– Improved quality of life
– Decreased secondary complications
• Especially decreased pain, decreased spasticity, increased bone density
– Improved health and wellness
Barriers to the Use of Exoskeletons
•
•
•
•
•
COST
Insurance coverage (or lack thereof)
FDA Approval
Safety?
Lack of research comparing outcomes of exoskeleton
training to other available therapies
• Lack of long term follow-up’s
AN IN-DEPTH LOOK AT THE DEVICES
Exoskeletons: What’s Available Today?
Device
Maker
More Information
Ekso
EksoBionics
Eksobionics.com
Indego
Parker Hannifin
Indego.com
ReWalk
Argo Medical
Rewalk.com
Rex
RexBionics
Rexbionics.com
• In this presentation, we’ll discuss the four most notable devices developed
in Europe and the United States.
– Ekso and ReWalk are being used in rehab centers with patients and also under
research/clinical trials.
– Indego and Rex are being used for research/clinical trials.
• How can you get your patients involved? Visit company websites (above).
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Who Can Use Exoskeletons?
• Generally all exoskeleton devices have similar criteria
• Persons with SCI or other neurological disorders such as
stroke, MS, or TBI
• Must have medical clearance for full weight bearing and
walking activity from MD
• Persons who are 5’1” to 6’3” tall, some variation per device
• Persons who weigh 220lbs or less, some variation per device
• Adults aged 18 and older who are not osteoporotic or at
increased risk for fracture
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Ekso
Developed by:
Ekso Bionics
Weight
~ 50 lbs
Portability
Device stays in one piece
Adjustability
Fully adjustable
Features
Backpack-style containing battery
Variable robotic assist
Subjects wear own shoes (standing on platform)
Can walk over all surfaces and ramps
(http://www.eksobionics.com/)
Assistive Device Platform rolling walker, rolling walker, or forearm crutches
How does it
work?
Steps are initiated in a number of ways depending on the chosen
program:
• First Step: new users with skilled PT; PT triggers each step manually
• Active Step: user takes control of push button on stability aid
• Pro Step: user activates with weight shift lateral and forward
• Pro Step Plus: user activates via weight shift + forward leg motion
Speed
Functional for inside or outside home at +/- 0.4 m/s
FDA Approval?
No
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Ekso Video
• Video from EksoBionics.
Let’s see the Ekso in action…
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Indego
Developed by:
Parker Hannifin
Weight
26 lbs
Portability
Modular, breaks apart into 5 pieces
Small enough to wear in a rigid frame wheelchair
Adjustability
Fully adjustable (modular components w/ adjustable AFO)
Features
No backpack; laptop-style battery contained in hip piece
Variable robotic assist
Functional electrical stimulation (FES)
Subjects wear own shoes (device fits inside shoes)
Can walk over all surfaces, ramps, and stairs
(http://www.indego.com/)
Assistive Device Platform rolling walker, rolling walker, forearm crutches, or cane
How does it
work?
Steps are triggered in a number of ways:
• Change in posture, like a “legged segway” (lean forward, walk
forward)
• Muscle initiation from the user (variable robotic assist mode)
• Can work in combination with FES at the trunk and legs
Speed
Functional for inside or outside home at +/- 0.4 m/s
FDA Approval?
No
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Indego Video
• Video from Parker Hannifin.
Let’s see the Indego in action…
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ReWalk
Developed by:
Argo Medical Technologies
Weight
~ 50 lbs
Portability
Device stays in one piece
Adjustability
Fully adjustable
Features
Backpack-style containing battery
Full robotic assist only
Subjects wear own shoes (device fits inside shoes)
Can walk over all surfaces, ramps, and stairs
(http://www.rewalk.com/)
Assistive Device Forearm crutches
How does it
work?
Steps are triggered by:
• Changing posture (using a posture-based tilt mechanism)
• The user wears a watch to control for modes (walking, sitting,
standing, etc.)
Speed
Functional for inside or outside home at +/- 0.4 m/s
FDA Approval?
Yes. Approved for use in rehabilitation centers (T4 and below) or at home
(T7 and below, with a caregiver)
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ReWalk Video
• Video from Argo Medical
Technologies.
Let’s see the ReWalk in action…
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Rex
Developed by:
Rex Bionics
Weight
~ 84 lbs
Portability
Device stays in one piece
Adjustability
Fully adjustable
Features
No backpack
Full robotic assist only
Subjects wear own shoes (standing on a platform)
Can walk over flat surfaces and stairs
(http://www.rexbionics.com/)
Sample of a BMI cap
Assistive Device No assistive device required; uses joystick controller
How does it
work?
Steps are triggered in one of two ways:
• Using joystick
• Brain motor interface (BMI) with skull cap, electrodes, and gel
Speed
Functional for inside, generally less than 0.4 m/s
FDA Approval?
No
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Rex Video
• Video from Rexbionics.
Let’s see the Rex in action…
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Robotic Exoskeleton Trials
Shepherd Center 2010- Present
Ekso™
2010 -2013
ReWalk™
2012
Indego®
2010 - Present
Thank you!
Questions?