This robotic exoskeleton helps paralysed patients to walk and it's getting smarter

We speak to Ekso Bionics about rehabilitation robotics and replacing the wheelchair
The wearable rehab robot
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Ekso Bionics has been making superhuman exoskeletons for the military for ten years. It's in the business of human augmentation. But, in 2012, it made the move into helping victims of lower body paralysis. Ekso co-founder and CTO Russ Angold witnessed the recovery of his brother, an ex-Navy SEAL who suffered a spinal cord injury, and had the idea to turn an exoskeleton trying to be an Iron Man suit into a medical device.

Fast forward to 2015 and its bionic GT rehabilitation suit is helping stroke victims, spinal cord injury patients and sufferers of other neurological conditions to re-learn how to stand and walk correctly, faster than regular physiotherapy.

This May, Bedfordshire-based Sarah Thomas who was paralysed in a road accident in Australia, was awarded an Ekso GT for home rehab as part of a High Court settlement in the UK. She joins over 1,000 patients who have strapped themselves in to this futuristic gait training robot.

Trained by the cutting edge rehab bot

The aluminium and titanium Ekso GT weighs 23kg but transfers all its weight onto the ground. It initiates steps through electric motors and can be controlled by a 'walker' pushing buttons behind the user or after time, with crutches. It uses a gyroscope, trajectory sensors and torque sensors to detect the level of assistance each user needs and processes these inputs 500 times a second to work out how much assistance to provide for every single step.

"It's a very, very clever piece of kit," Andy Hayes, Ekso Bionics' managing director for EMEA, told Wareable. No kidding.

"From the moment someone first takes their step in Ekso, Ekso will decide how much assistance level to give them," he continued. "So if an able-bodied person got in Ekso, it would know that you're able-bodied and theoretically it would give you zero percent assistance.

"If a hemiplegic patient uses it, a stroke victim, it would know half your body is paralysed and half your body is good and it would just give you the assistance level you need. For someone who has had a complete spinal cord injury, so someone who just can't walk, Ekso will do the walking for them."

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Walking speed depends on each user and the different modes available include: FirstStep in which a trainer or 'spotter' pushes buttons to initiate steps, ActiveStep in which the user pushes buttons themselves on the GT or crutches, ProStep where the user moves their hips and the final level, ProStepPlus which also involves the wearer shifting their weight and moving their legs forward to make steps.

Accessing the future

Ekso's devices cost over $100,000 per unit but patients are able to access them in clinics, via charity or medical legal cases. The company is also looking into how patients could be reimbursed against the cost since health and secondary care services will save money.

We're not replacing the wheelchair
... yet

There are four Ekso GTs in UK hospitals (one NHS in Sheffield) and private clinics as well as one awarded to ex army officer Dale Messenger in a similar medical legal case to Sarah Thomas' case. Around the world, the exoskeleton is already in use in France, Germany, Italy, Czech Republic and South Africa as well as 50 in the US where Ekso Bionics is also pioneering the use of exoskeletons in construction industries.

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Users with an exoskeleton at home need to be trained for twenty hours with a physiotherapist before home use but the GT can also be used as a short term training tool. A study in the US of nearly 50 patients who had suffered from a stroke found that those who walked with an Ekso before they left hospital had a 50% higher independence score than those who used traditional physio techniques.

"It's quality of life," said Hayes. "If you can be discharged as a stroke patient, with a 50% higher level of independence, that's got a huge benefit to the economy and to the tertiary care/secondary care and the family as well. And in Dale Messenger's case, he walks on Ekso instead of taking pain medication for agonising pain in his weaker leg."

What comes after the wheelchair?

Ekso Bionics is focusing on rehabilitation and training right now but a few times during our chat, the prospect comes up of patients using exoskeletons to stand and walk around day-to-day in the future.

"We're not at the stage of a mobility device, we're not replacing the wheelchair... yet," said Hayes. "But it won't be a million years before people are walking in exoskeletons instead of wheelchairs. The technology is there, it's just very advanced and very expensive.

"We also don't want to over promise people, spinal cord injury and stroke are severe incidents. We don't want people to think suddenly they can magically walk with an exoskeleton. Right now this is a training device."

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Ekso has a 100% safety record in Europe and the last thing it wants is patients falling and injuring themselves. Wearing gait support rather than wheeling around in it might have its advantages in the real world but there's also work to be done around making the process more practical from start to finish.

"Imagine you wanted to go to the shops," said Hayes. "You could just go in your wheelchair or you could strap on this exoskeleton, have someone push your buttons and walk there at a relatively low speed compared to the wheelchair. So it needs to really be a solution and one that's customisable for the individual."

Future exo

It might be hitting headlines and expanding globally but Ekso Bionics welcomes competition. Patients have already taken 17 million steps in rehab Ekso devices and the company is now busy turning "quite a lot of data" into meaningful clinical evidence to prove the benefits of using an Ekso GT over traditional therapy.

"As time goes by, more competitors will come into the market, our research will become more validated and we will hopefully begin to see gold standards of care," said Hayes.

"We're leading the field. No other exoskeleton has the Smart Assist software which detects how much assistance to give to a user and we've just launched functional electrical stimulation which is a therapy for patients who are losing muscle mass. We're on the third generation of hardware and the fifth generation of software already. It's advancing all the time, there's so many more things we can do."

Put it this way - for anyone interested in the future relationship between machines and our fragile, limited human bodies, Ekso Bionics is one to watch.