George Stewart sits in his wheelchair wearing the Indego exoskeleton. His wife Paula secures straps, checks foot placement, and centers a walker in front of him. George clicks a button on his hip and says, “We’re going green, Paula!” then leans forward and pushes up, triggering the Indego and George to stand. George exclaims, “I’m up, I’m out of this chair, I’ve got freedom again.”
George and Paula have come a long way since 2013, when George was in a work accident that left him paralyzed from the waist down after being run over by a tractor-trailer. “I spent nine weeks in the ICU, then three and a half months at the Shepherd Center in Atlanta, GA. I’ve done quite a bit of therapy to get me to this point,” George shares. “The Shepherd Center is where I first saw the Indego exoskeleton. But I was afraid that insurance wouldn’t approve it for me, so I just left it alone.”
Fast forward nearly five years to South Charleston, West Virginia.“I brought my uncle to his appointment at First Settlement Physical Therapy and saw Lyle training with the Indego exoskeleton. I learned that Lyle got insurance approval for his Indego exoskeleton because of his work injury, so I decided to try and get one too.” George presented his case and information about Indego to his insurance company, and two weeks later, he received a call telling him he was approved. “I was astonished, believe me, quite astonished!
When describing his Indego training program, George shares, “It’s been hard at times, then it eases back up. But anything you do with a spinal cord injury is going to be hard, to begin with, I don’t care what it is. I remember being at Shepherd Center flat on my back, trach in, couldn’t roll over, couldn’t sit up. Was it hard? Yeah! But with five days of therapy per week, I found ways to work through it. Same thing with Indego.”
George trained using the Indego exoskeleton five days per week for an hour per session. After mastering all the basic skills and knowledge required for Check-Off Day, George and his wife were cleared to take the Indego exoskeleton home for personal use on December 3, 2019. George grins and says, “I’ve got a Christmas surprise planned. My family lives 130 miles away, but we’re all getting together for Christmas. My Indego exoskeleton has been a well-kept secret. A hard-kept secret but a well-kept secret. Paula and I will sneak off into a separate room to put it on, then walk into the living room where the family is for quite a surprise.” George and Paula share huge smiles and laughter as they share their plans for the big day. “My mother is 91, and it will be quite a shock and surprise for her to see me standing up again. It will be quite a shock for everyone! What their reactions will be, I have no idea.”
“My daughter graduates from nursing school in July of next year. My plan is to walk across that stage and be the one who gets to pin on her nursing pin at graduation. What better place to showcase the Indego personal exoskeleton”, George exclaims, “than in front of all the doctors and nurses in the crowd at graduation.”
As George and Paula pack up their Indego exoskeleton to take it home for the first time, George shares, “I think the Indego will give me longevity. It will keep me from sitting, it will keep me moving. Even at 70 or 75 years old. Now I can get up, and I can stay up! I can drink a cup of coffee while I’m standing. I can change the light bulbs in the house. Now I can look at somebody eye to eye, rather than always looking up. That makes a big difference. That’s one of the best things about it.”
When asked if there’s anything special he wants people considering the Indego exoskeleton to know, George states, “Definitely go for it! I’d sit down with anybody and share my story with them and answer any of their questions. It’s been a great experience, and I look forward to even better experiences now that we’re taking it home.”
The Indego Difference
Indego is a leading exoskeleton provider that focuses on personal and clinical mobility rehabilitation solutions. Our exoskeletons use proprietary software that is customizable to the patient’s needs and goals. Furthermore, our solutions are designed to be intuitive and easy to use in any environment.
There’s been an explosion in the creation of rehabilitation technology over the last 10 years. As rehabilitation professionals, we’re fortunate to provide our patients with more opportunities for recovery than we ever have. However, these technologies are often costly capital purchases which can be challenging to justify in an environment where reimbursement rates and lengths of stay continue to decline. Therefore, it’s essential to critically evaluate each piece of technology for potential purchase to ensure maximum return on investment for our specific patient populations.
Interdisciplinary Team Evaluation
When evaluating a piece of rehabilitation technology, it’s vital to take an interdisciplinary approach to ensure stakeholders’ needs are met. Some of the groups you should involve in the evaluation process include:
Therapists who will be using the technologies daily.
Senior administrators who understand the financial impact of the technology.
Researchers to evaluate the research potential of the technology.
Engineering to assess maintenance and warranty issues.
Most importantly, patients and caregivers in order to understand their true goals and priorities.
5 People Who Should Be Involved in Exoskeleton Purchase Decisions
1. Therapists: Acceptance and Responsibility
Therapists are extremely motivated to help patients recover. They commonly go above and beyond to ensure their patients reach their maximum potential. In order to embrace technological advances, they need to be included in the decision-making regarding the initial purchase of a piece of advanced technology as well as how to implement the device in their continuum of care.
When making these purchasing decisions, therapists must be responsible for evaluating the clinical utility of these technologies, such as how many therapists/aides are required for the initial setup of the device and how long the setup process takes. They need to complete a literature search to understand the known efficacy of the interventions provided by these technologies for the specific patient populations they treat. They must also put time and thought into how these devices will be implemented into their continuum of care, from inpatient rehabilitation through outpatient and community programs. This information will be a large part of their contribution to the interdisciplinary team evaluation of advanced technologies for purchase in their organization.
2. Senior administration: Cost Approval
A member of the senior administrative team must be included in the evaluation of exoskeleton purchases. This team member is responsible for understanding the financial picture of purchasing this device, including, but not limited to, the following: initial capital purchase price; ongoing maintenance, and warranty packages; and must share with the team the fiscal priorities for the organization over the next 3-5 years. It is crucial to understand not only the immediate impact of a piece of advanced technology but also to consider how this investment may or may not support the organization’s five-year strategic plan.
3. Researchers: Viability Reports
Members of the organization’s research department should provide the interdisciplinary team with a perspective of potential research gaps that exist with the advanced technology being evaluated. They, too, should complete a thorough literature review before meeting with the interdisciplinary team and reviewing potential grant opportunities. They must share their knowledge regarding the opportunity to conduct research with this specific technology and potential upcoming funding opportunities.
4. Engineers: Maintenance Expertise
Advanced rehabilitation technologies often include a complex interaction of hardware and software. When technologies are first on the market, they can often exhibit software and hardware challenges even during the first year they are acquired. They also often come with yearly warranty packages with a very hefty price tag. It’s essential for the engineering department to critically evaluate the in-house expertise they have to manage both the hardware and software of each specific piece of technology.
Many hospitals now employ mechanical and electrical engineers who may be able to troubleshoot and fix small problems that occur with these advanced technologies. Along with evaluating in-house expertise, a thorough understanding of the cost of the warranty package and its coverage is fundamental to the decision-making process.
5. End-Users: Patients and Caregivers Opinions
Patients’ and families’ perspectives are critical in making successful decisions about which types of exoskeletons the clinic should purchase. It’s important to include patients and families on this team and/or to survey patients from the various diagnostic groups in order to truly understand what type of recovery and opportunity for recovery is most important to them. Patients and families are very savvy regarding what types of advanced technologies are now available, and many anecdotally report that technology availability is included in their decision-making process when determining which rehabilitation hospital they choose for themselves or their loved ones. This information should be gathered and provided to the interdisciplinary team to be included in the decision-making process for an exoskeleton purchase.
Why We Purchased Indego Exoskeleton in Our Clinic
Our organization utilized the perspectives of the various team members reported above when purchasing the Indego exoskeleton in 2016. Craig Hospital was involved in a multi-center research study utilizing the Indego in 2015. This research opportunity provided therapists with first-hand knowledge of the system in terms of clinical utility (patient appropriateness; setup time; the number of staff required for safety), allowing them to bring a unique hands-on clinical perspective to decision-making. The therapists involved in the trial reported a very positive experience with the system and advocated for its purchase.
As an administrator, I evaluated the opportunity for integration throughout our continuum of care and assessed the financial impact regarding patient lengths of stay, outpatient benefit limits, and involvement in our community wellness program. In addition, wanting to maintain Craig’s position as a leader in spinal cord injury and traumatic brain injury rehabilitation and research (one of the foundational aspects of our five-year strategic plan) led me to support the purchase of the Indego exoskeleton.
Our research team evaluated the many gaps (bone density, recovery of walking, balance reaction training, and much more) in the literature surrounding exoskeletons and agreed there was great potential to make meaningful contributions to this field and also supported the purchase of this device. Our engineering team had experience with the system during the research study and felt comfortable with the response time and follow-through from the Parker Hannifin technical support team.
Most importantly, the subjects and families who participated in the trial really enjoyed using the device and reported that they believed this technology was among the “next steps” in neurorehabilitation and should be a part of the care we provide at Craig Hospital. Therefore, the decision from the interdisciplinary team was to purchase this device as soon as the FDA approved it for personal use.
With the increasing opportunities to provide our patients with the latest rehabilitation technologies also comes the responsibility to vet each technology carefully to ensure we’re providing our patients with an optimal opportunity for recovery while focusing on technologies that improve their quality of life.
Candy, PT, DPT, ATP, NCS is the Director of Physical Therapy at Craig Hospital. Candy received a B.S in Biology from Mount Olive College in 1997 and a Master’s in Physical Therapy from East Carolina University in 2000. She then completed a Doctorate of Physical Therapy degree from Rocky Mountain Health Care University in 2008. Candy has been working in the field of neurological rehabilitation since 2000 and received an assistive technology practitioner (ATP) certification in 2005 and became a certified neurological clinical specialist (NCS) in 2007. She has been involved in numerous research projects and has focused much of her career on interventions and program development promoting recovery after neurologic injury or disease. Candy is a member of the American Physical Therapy Association and the Neurologic Section.
Craig Hospital is a world-renowned, 93-bed, private, not-for-profit rehabilitation hospital and research center that specializes in the care of people who have sustained a spinal cord and/or a brain injury. Craig provides a comprehensive system of inpatient and outpatient medical care, rehabilitation, neurosurgical rehabilitative care, and long-term follow-up services. Half of Craig’s patients come from outside of Colorado. Craig has been ranked as a top 10 rehabilitation center by U.S. News and World Report for 27 consecutive years. Craig has received the NDNQI® award in 2009, 2012, 2013, 2014 and 2015 for the highest quality outcomes in nursing care in a rehabilitation facility. Craig was voted by employees as a “Top Work Place” by the Denver Post for the past three years and was ranked in the top 150 places to work in healthcare by Becker’s Healthcare in 2014.
The exoskeleton market has seen significant growth over the last few years and is expected to keep growing. As a result of advanced technology, several companies have risen to the top of the industry. In this article, we will take a look at some of the most incredible exoskeleton companies and startups making waves in 2023.
What Are Exoskeletons?
An exoskeleton is a wearable device that is designed to enhance human strength and performance. It is composed of a frame (worn outside the body), motors, levers, and actuators that power the exoskeleton. Exoskeletons have different applications, including health care, industrial work, and military operations.
Health care: In health care, exoskeletons are mainly used in medical rehabilitation to help patients regain movement and strength in their limbs after an injury or illness. They are used to provide support in the knee and hip joints, which allow patients to stand and walk.
Industrial Work: Exoskeletons are normally used in construction and automotive industries to reduce fatigue and the risk of injury for workers who perform repetitive tasks or heavy lifting. They are also used to increase efficiency.
Military Operations: Exoskeletons are used in military operations to enhance the physical capabilities of soldiers. They assist soldiers in carrying heavy equipment over long distances and provide extra protection during combat operations.
The Rise of the Exoskeleton Market
The exoskeleton market has been growing rapidly over the past decade and is expected to reach a valuation of 26,469.20 Million USD by 2030. That’s a compounded annual growth rate of 48.23%. [1]
This massive growth is fueled by several factors. One of the main drivers is the increasing demand for exoskeletons in medical rehabilitation. Exoskeletons have been reported to be effective rehabilitation tools in gait training, balance, and coordination. As such, they have grown in popularity as a new rehabilitation method helping patients with spinal cord injuries, stroke, and other conditions regain mobility and muscle strength.
Another factor driving the growth of the exoskeleton market is the growing use of exoskeletons in industrial settings. They are a great solution, especially for workers in the construction and automobile industries who complete a lot of overhead work and repetitive tasks. Exoskeletons help increase efficiency and productivity while reducing the risk of injury. Some companies like Ford have even made exoskeletons a mandatory part of their personal protective equipment (PPE).
The military is also a significant market for exoskeletons. They utilize exoskeletons in combat to enhance the physical capabilities of soldiers and to reduce the risk of injury. With the help of exoskeletons, soldiers can easily carry heavy weapons and equipment over long distances without overexertion.
Furthermore, there is also a growing interest in exoskeletons for personal use in sports, entertainment, and for individuals with mobility impairments.
Medical Exoskeleton Companies in 2023 To Keep an Eye On
The following is a compilation of notable exoskeleton companies making significant strides within the industry presented in no particular order:
Bionik Laboratories
Bionik Laboratories creates arm and hand retraining robotics for occupational and physical therapy treatments. It was co-founded by Michal Prywata in 2010 and is located in Toronto, Canada. Their leading solution is InMotion Therapy which is an upper extremity rehabilitation exoskeleton for patients with neurological injuries.
Cyberdyne
Cyberdyne is a Japanese company that was founded in 2004. It is located in Gakuen-Minami, Tsukuba, Ibaraki Prefecture, Japan. It specializes in the development of robotic exoskeletons, which augment the abilities of people with mobility impairments, such as paralysis or muscle weakness. Their flagship product is the HAL (Hybrid Assistive Limb) exoskeleton, which uses brain signals to help people recovering from spinal cord injuries or other forms of paralysis to stand and walk. Cyberdyne also develops other products, such as the HAL for elder care, which is used to help elderly people with mobility impairments.
Ekso Bionics
Ekso Bionics was created by Homayoon Kazerooni in 2005 and is located in San Rafael, California. It’s one of the biggest medical exoskeleton manufacturers with use in over 400 centers globally. It was one of the first companies to receive FDA approval for its medical exoskeleton. EksoNR, their flagship product, is used for physical therapy for patients with stroke, multiple sclerosis, spinal cord injury, or traumatic brain injury. A lot of research has been conducted to test the effectiveness of their exoskeletons in improving mobility and quality of life for people with disabilities, as well as to explore new applications for the technology.
Recently, Ekso Bionics acquired Indego Exoskeletons, a creation of Parker Hannifin. This acquisition will see it maintain its position as one of the best companies in the market.
Honda
Honda, the developer, and supplier of motorcycles, automobiles, and power equipment, was established by Takeo Fujisawa and Soichiro Honda in 1948. As unlikely as it may seem, Honda doesn’t just create cars and motorcycles. It also creates a lightweight exoskeleton that is designed to help people with moving difficulties. The Honda Walking Assist is a lightweight exoskeleton designed for individuals who can walk but have gait deficits resulting from a stroke. It is worn around the waist and legs and helps improve walking patterns, allowing users to walk faster and farther. It is also believed to help with neuromuscular recovery when used in a clinical setting by trained healthcare professionals.
Ottobock
Ottobock was founded in 1919 by Otto Bock and is headquartered in Duderstadt, Germany. Ottobock is popularly known for its prosthetics but joined the exoskeleton industry by acquiring SuitX. Ottobock produces exoskeletons that are aimed at the professional audience. In the medical field, it produces exoskeletons for surgeons to help reduce fatigue, tremor, and long-term musculoskeletal disorders.
Rewalk Robotics
ReWalk Robotics, located in Marlborough, MA, was founded in 2001 by Amit Goffer, an Israeli engineer. His personal experience inspired his invention after he was paralyzed in an ATV accident in 1997. ReWalk helps individuals with spinal cord injuries stand and walk. It is controlled by a computer and powered by motors at the hip and knee joints. The ReWalk is intended to provide users with increased mobility, independence, and improved quality of life.
Rex Bionics
Rex Bionics is a robotics company that creates lower-limb exoskeletons for people recovering from spinal cord injuries. It was launched in 2003 and is headquartered in Rosedale, New Zealand.
Fast-Rising Medical Exoskeleton Startups
Fourier Intelligence
Fourier Intelligence was founded in 2015 and is located in Shanghai, China. It has an estimated funding of 83 Million USD and offers exoskeleton rehabilitation for upper and lower limbs. Its flagship product is the ExoAtlet II, which helps patients with SCI, multiple sclerosis, and cerebral palsy improve their gait, balance, coordination, and independence.
Seismic
Seismic is a robotics company that takes a unique approach to strength augmentation. It creates apparel that helps increase muscle strength in the elderly population. This technology can be worn under any apparel to augment strength and increase the natural movement of muscles and joints. Seismic was founded in 2015 and is located in Menlo Park, USA, with an estimated funding of 16 Million USD.
Trexo Robotics
Trexo Robotics is a robotics company that specifically focuses on children with disabilities. Its flagship product is a battery-operated exoskeleton for children with a diagnosis of cerebral palsy, brain injury, paraplegia, spinal cord injury, Rett syndrome, neuromuscular disease, stroke, hemiplegia, or degenerative lower extremity joint disease. Their product is versatile and can be attached to other walkers and gait trainers. Trexo Robotics was founded in 2016 and is located in Mississauga, Canada, with an estimated funding of 2 Million USD.
Wandercraft
Wandercraft was founded in 2012 and is located in Paris, France. It has an estimated funding of 67 Million USD. Its flagship product is Atalante X, which enables people with reduced mobility and neuromuscular disorders to walk again.
Conclusion
This is in no way a comprehensive list of the many exoskeleton companies making a difference out there. These are just a few examples of the companies that have caught our attention. And as exoskeletons continue to improve and become more widely adopted, we’re likely to see a bigger surge in demand and a transformation in how we live and work. It’s an exciting time, and we can’t wait to see what the future holds.
Ekso Bionics is a leading manufacturer of rehabilitation exoskeleton technology with more than a decade of experience in helping patients walk again. Our medical exoskeletons are used in more than 400 rehabilitation centers worldwide, and if you’d like to learn more or talk to us, visit our contact page today.
