Author: darrienda

Spinal cord injuries (SCI) can be life-altering, often resulting in limited mobility and loss of independence. For individuals with SCI, rehabilitation is crucial to regain as much function as possible. One groundbreaking technology that is helping many in their recovery journey is the use of exoskeletons. These wearable devices, once the stuff of science fiction, are now playing a significant role in both hospital and home settings. They offer new hope for people with SCI by helping them walk again, enhancing mobility, and improving overall health outcomes. 

In this blog, we’ll explore how exoskeletons are used from the hospital to home. We’ll also discuss some of the concerns potential exoskeleton users have, including Medicare coverage and insurance coverage for an exoskeleton. 

What is an Exoskeleton? 

An exoskeleton is a powered wearable device designed to assist human movement, particularly for those who have experienced a mobility impairment, such as from a spinal cord injury or stroke. Historically, these devices have only been used in rehabilitation, and this is still where you are most likely to use one. Some models are now also available for home and community use. 

Exoskeletons for people with SCI are controlled in different ways to allow and support walking. Using an exoskeleton also allows people who typically use a wheelchair to stand up. This provides health improvements like maintaining range of motion, decreasing spasticity, preventing muscle atrophy, improving cardiovascular health, and aiding with bowel and bladder voiding. Some exoskeletons like Ekso Indego are controlled through postural positions, so a user does not have to have any strength in their legs to be able to walk. The motors can also decrease how much assistance they provide, if the user is able to contribute partially to the movement using their own strength.  

By supporting the user’s weight and guiding their legs through walking motions, an exoskeleton can help the individual regain a sense of independence, retrain their muscles, and, in some cases, even improve their long-term mobility enough to have them “walk out” of the exoskeleton. 

Using an Exoskeleton in a Hospital Setting

After experiencing an SCI, a person will first be transported to an acute care hospital to become medically stabilized. Once they are ready for more intensive rehabilitation, a physical therapist typically determines if a patient with SCI is a good candidate for exoskeleton therapy, like EksoNR. This decision is based on factors including the patient’s weight, therapy goals, and other health concerns. Once a patient is deemed appropriate for exoskeleton therapy by their physician and care team, they will undergo a formal evaluation and measurements to assure that the technology is right for them. 

The EksoNR exoskeleton provides advantages to those early in their rehabilitation, making it the perfect tool to utilize during this hospital-based stage. It supports the user through the trunk, allowing those with poor trunk control to stand up and walk, even though they may struggle to sit at the edge of the bed. EksoNR can provide full assistance to those who are weak but can also take assistance away as the patient gets stronger. EksoNR provides support through the legs preventing buckling, which could cause a fall. This allows the therapist the ability to focus on the quality of gait instead of just focusing on safety. All these features allow EksoNR to be used as early as possible in rehabilitation, which is critical for recovery. Sessions in EksoNR may focus on balance, pre-gait activities, walking, or strengthening.  

EksoNR also allows the therapist to create the most perfect stepping pattern for each patient. Learning how to walk correctly can help to reduce complications later including pain and decreased endurance. The goal of using a robotic exoskeleton in rehabilitation may be to help the patient relearn how to walk so that they can leave the hospital on foot, or it might be to help the patient master skills such as weight shifting which will allow them to be as independent as possible with transfers and daily activities.  

The feedback provided by EksoNR can help therapists ensure that patient’s progress is closely monitored, and adjustments are made as needed. It also allows therapists to make sure they are appropriately challenging the patient.  

Using an Exoskeleton in the Outpatient Setting

Once a patient is discharged home from the rehabilitation hospital, they likely will continue to receive therapy through an outpatient facility. Patients may continue to use a rehab exoskeleton in this setting to fine-tune their gait, continue strengthening, and gain more independence. 

The Ekso Indego Therapy exoskeleton is one option of a robotic exoskeleton that may be used in this setting. Ekso Indego is lighter and supports only through the hips, making it feel less restrictive. It knows when to take a step based on postural position, and it is very easy to learn.  

Ekso Indego can be used by any trained healthcare professional for patients with multiple goals. Similar to EksoNR, assistance provided by the device can be adjusted to challenge the patient who is regaining strength in their legs. For those with SCI who may need an exoskeleton at home long-term, using it in therapy can be a great start to learning the device and seeing if it is right for you. You can also get a sense for if the device will help you meet your specific goals for the home and community.  

Advantages of Rehabilitation Use – Inpatient and Outpatient 

Using an exoskeleton under the guidance of a healthcare professional offers several benefits: 

1. 1. Medical Supervision: Therapists can offer real-time feedback and make necessary adjustments to the device. 
   2. Safety: Controlled environments ensure patient safety, minimizing the risk of falls or injuries. 
   3. Team-Based Approach: A coordinated team of doctors, therapists, and technicians work together to create the best possible rehabilitation plan. 
   4. Early use: Soon after an injury is the perfect time to capitalize on rehabilitation as the body is primed to learn. 

By combining exoskeleton therapy with other forms of physical rehabilitation, patients may see faster results and make significant strides in their recovery. 

Transitioning to Home Use of an Exoskeleton 

For those who are eligible, having an exoskeleton for use at home is now an option. Eligibility is based off a number of factors including health status, level of injury, and body size. This device would not replace a wheelchair but would allow users to stand and walk in their home and community with the supervision of a support person. This support person can be anyone: a spouse, parent, child, or caregiver who will receive device training with the user. 

The Ekso Indego Personal exoskeleton is the perfect device for home and community use because it is modular and lightweight. It breaks down into 5 separate pieces which can be placed in a duffle bag, making it easy to bring from place to place. It also can be worn by a passenger in a car.  

Home exoskeleton devices like Ekso Indego Personal can also walk on different surfaces and inclines. They can be used anywhere a wheelchair could. Having a personal exoskeleton for home provides the user both physical and mental health benefits. Simple tasks like washing dishes or looking in the mirror while brushing your teeth are more challenging or impossible from a sitting position. Ekso Indego Personal allows the user to complete chores and activities like these from standing. 

Both the patient and their support person will undergo training to ensure safe and effective use of the exoskeleton at home. This training covers how to properly wear and control the device, navigate various terrains, and use it in different daily activities.  

While the exoskeleton can’t replace all mobility aids, it can complement the use of a wheelchair by providing an option for standing and walking. 

Advantages of Home Use 

1. 1. Increased Independence: The exoskeleton provides the ability to move in ways that would otherwise be impossible, increasing the patient’s independence. 
   2. Health Benefits: Regular movement with an exoskeleton can improve cardiovascular health, strengthen muscles, and prevent complications like pressure sores. 
   3. Improved Mental Health: Regaining mobility, even partially, can significantly boost mental well-being and confidence. 

Cost Considerations    

One of the biggest challenges for individuals seeking to use an exoskeleton for home and community use is the cost. Exoskeletons are sophisticated pieces of technology, and this comes with a high price tag. Veterans and persons who are covered under workers compensation insurance are eligible to receive a personal exoskeleton at little to no cost. Medicare coverage for personal exoskeletons like Ekso Indego Personal may be available for eligible beneficiaries. We expect other insurances to follow suit in the future, providing insurance coverage for this life-changing technology. The team at Ekso Bionics can help determine if insurance may cover all or part of the cost for any interested individual.  

 

Using a personal exoskeleton like Ekso Indego Personal can be a game-changer for individuals with spinal cord injury (SCI), offering enhanced independence and improved quality of life. However, maximizing the benefits of your exoskeleton requires commitment, practice, and a solid understanding of how it operates. This blog post will guide you through essential steps to ensure you are as successful as you can be with your personal exoskeleton.

The Importance of Using the Device Often

Consistency is Key:

Build Strength and Endurance:

Regular use of your exoskeleton helps build the necessary muscle strength and endurance required for optimal performance. Like any new skill, the more you practice, the more proficient you become.

Adaptation to the Device:

Your body needs time to adapt to the exoskeleton. Frequent use helps you become more comfortable and confident, reducing the learning curve and making the device feel like a natural extension of your body.

Maximize Therapeutic Benefits:

Consistent use may enhance the therapeutic benefits of the exoskeleton. Repetitive movements facilitated by the device can promote neural reorganization and muscle reconditioning, potentially leading to long-term improvements in mobility. Regular use could also result in improvements in bowel and bladder program, bone strength, cardiovascular health, and more.

Maintain Mobility:

Regular use of the exoskeleton helps maintain and even improve your current level of mobility. It prevents muscle atrophy and joint stiffness, which can occur if you remain sedentary.

Learning How to Balance

Balance is Fundamental:

Start with Supervised Training:

Begin your journey with your exoskeleton under the supervision of a certified Indego specialist. They will provide valuable education and guidance on how to maintain balance and ensure you are using the device correctly.

Practice Standing and Walking:

Spend time practicing standing still and walking in a controlled environment. Focus on distributing your weight evenly and maintaining a steady posture. Think about moving your torso just slightly over your stance leg to allow the other leg to step.

Engage Your Core:

Strengthening your core muscles is crucial for maintaining balance. Engage your core while using the exoskeleton to provide additional stability and support.

Learn to Sequence your Assistive Device:

Start slowly and focus on when and where you are moving your walker or crutches. These assistive devices are crucial to keeping your balance and your chest upright.

Make Sure you Understand your Settings

Understanding Your Device:

Read the Manual:

Thoroughly read the user manual provided with your exoskeleton. Familiarize yourself with the different settings, functions, and safety features of the device.

Attend Training Sessions:

Participate fully in training sessions. Ask questions and offer to return demonstrations of the skills your trainer is teaching. Take videos or pictures to help you remember.

Experiment with Settings:

Spend time learning what the different settings are and which ones are safe for you to adjust on your own. Learn how they affect your mobility.

Keep a Log:

Maintain a log of the settings you use and how they impact your walking experience. This can help you track what works best and make informed adjustments as needed.

Practice any skill under supervision:

Trial walking on different surfaces, standing in front of the sink to simulate brushing your teeth, and walking down ramps if you think these are activities you will do.

Is Ekso Indego Personal the right exoskeleton for you? Learn more here. 

Advancements in mobility aids have significantly transformed the lives of individuals with spinal cord injuries (SCI). Among these innovations, personal exoskeletons and knee-ankle-foot orthoses (KAFOs) stand out for their unique contributions to enhancing mobility. While both serve the purpose of aiding walking, the experience of using each is distinct. This blog post explores the differences between walking in a personal exoskeleton and walking in bilateral KAFOs. 

Understanding KAFOs 

KAFOs are orthopedic devices that provide support and stability to the knee, ankle, and foot. These devices can be traced historically back to around 1200 BC and have been used for a variety of ailments, notably Polio in more recent times. Typically made from a combination of metal, plastic, leather, and velcro, they are custom-fitted to each user. KAFOs are commonly prescribed for individuals with conditions such as multiple sclerosis, cerebral palsy, or spinal cord injuries. They can be worn on both legs (bilateral) or just one (unilateral). Most people with spinal cord injuries use KAFOs on both legs. 

Walking in KAFOs: 

Stability and Support: 

KAFOs provide structural support, maintaining the alignment of the knee, ankle, and foot. This stability helps prevent the collapse of the leg during stance phase of walking. Often, those with SCIs use KAFOs that have a locked knee, meaning the knee remains straight, or extended, throughout any standing or walking.  

Energy Expenditure: 

Walking in KAFOs can be physically demanding. Users often need to exert considerable effort to move their legs, particularly if muscle strength is limited. A 1985 article found that the energy cost of walking in KAFOs in patients with T4 or lower SCI was about 8 times higher than normal walking. [1] The rigid structure of the KAFOs can lead to a gait that is less fluid and more laborious. The wearer also has to manipulate the weight of the KAFO, which is approximately 2-4 extra pounds per leg.  

Donning and Standing: 

Putting KAFOs on without assistance is possible but requires some flexibility. When KAFOs are worn bilaterally, standing requires significant upper body strength, as both legs will be straight in front of you with your heels on the floor when you are sitting. The user will have to rely entirely on their arms on crutches or a walker to get them into a standing position.  

Gait Pattern: 

The gait pattern with KAFOs tends to be less natural because of the knees staying extended. Users will likely exhibit compensatory movements, such as hip hiking or circumduction (swinging the leg outward), to facilitate steps. Users also tend to rely heavily on their arms to help generate forward momentum.  

Customization: 

KAFOs are tailored to fit each individual’s anatomy and needs. Proper fitting is crucial for comfort and effectiveness, often requiring adjustments over time. These adjustments and fitting are completed by an orthotist. 

Understanding Personal Exoskeletons 

Personal exoskeletons are wearable robotic devices designed to augment human movement. They are equipped with motors, sensors, and sophisticated control systems that can assist or enhance the user’s mobility. Exoskeletons are used in rehabilitation settings but also can be used by a person in their home or community. Personal exoskeletons are partially or fully paid for by Medicare, Veterans’ benefits, or workers compensation for eligible individuals. Having a personal exoskeleton allows a person with SCI, with the supervision of their support person, to complete activities of daily living (ADLs), exercise, and leisure activities from a standing position. Personal exoskeletons can go most places that your wheelchair can go.

Walking in a Personal Exoskeleton: 

Stability and Support: 

Personal exoskeletons utilize motors to help keep extension on the standing limb(s) to keep you upright. These are powered by a rechargeable battery. Personal exoskeleton devices, like Ekso Indego Personal, also include fall mitigation strategies to assure the user falls in the safest possible way if they were to lose their balance.  

Energy Expenditure: 

Personal exoskeletons provide powered assistance, reducing the physical effort required for walking. This assistance can be particularly beneficial for individuals with significant muscle weakness or paralysis. The weight of the personal exoskeleton is carried by its motors. With the powered assistance of a personal exoskeleton, users typically expend less energy compared to walking in KAFOs. This can enhance endurance and enable longer periods of walking. 

Donning and Standing: 

Ekso Indego Personal is the only modular exoskeleton on the market, allowing for easy donning piece by piece. The exoskeleton can be put on by most users independently. There is a programmed standing sequence that relies on the power of the motors to help you get into standing in a natural way, starting with your knees bent and feet flat on the floor. 

Gait Pattern: 

Advanced personal exoskeletons are designed to mimic natural human gait. Sensors and algorithms continuously adjust the movement to ensure a smoother and more natural walking pattern. This can improve overall mobility and reduce the risk of compensatory injuries. It also means that there is less reliance on the upper extremities. 

Customization: 

Personal exoskeletons offer different hardware sizes as well as programmable settings that can be adjusted to suit the user’s needs. Parameters such as walking speed, step length, and level of assistance can be fine-tuned to optimize performance and allow completion of different activities in the home and community. 

Comparing the Experiences

1. Level of Assistance:

KAFOs primarily provide structural support without actively assisting movement. Personal exoskeletons, on the other hand, offer powered assistance, significantly reducing the effort required to walk.

2. Gait Quality: 

The gait pattern with KAFOs can be less natural due to the rigidity of the device and the user’s compensatory movements. Personal exoskeletons are designed to replicate natural gait, offering a smoother and more comfortable walking experience. This natural gait pattern also helps to reduce overuse injuries to other joints and muscles.

3. Energy Expenditure:

Walking in KAFOs can be physically taxing, leading to quicker fatigue. Personal exoskeletons reduce the energy required for walking, allowing users to walk longer distances with less effort. This is especially helpful for those with the goal of community integration – whether that is going for walks in a park or running errands.

4. Adaptability:

KAFOs require customization for proper fit and function but lack dynamic adjustability. Personal exoskeletons offer adjustable settings that can be personalized in real-time to meet the user’s evolving needs and goals.

5. Acquisition and Learning:

Both KAFOs and personal exoskeletons are categorized as braces. KAFOs, being less advanced technology, are cheaper and easier to learn. However, they may take longer to master independent use because of the significant upper body strength they require, especially to accomplish a sit to stand. Personal exoskeletons have a higher price point and require more time up front from the user and their support person to master. 

Conclusion 

Both KAFOs and personal exoskeletons play crucial roles in enhancing mobility for individuals with spinal cord injuries. The choice between the two depends on various factors, including the user’s specific condition, mobility goals, and lifestyle. KAFOs provide necessary structural support, while personal exoskeletons offer advanced, powered assistance that can transform the walking experience. As technology continues to evolve, the integration of these devices promises to further improve the quality of life for many individuals, offering newfound freedom and independence. 

Is Ekso Indego Personal the right exoskeleton for you? Learn more here. 

In a groundbreaking move, Medicare has finalized reimbursement guidelines for Ekso Indego Personal, marking a significant milestone in healthcare accessibility for individuals with spinal cord injury. This decision represents a long-awaited breakthrough for many beneficiaries who could benefit from innovative assistive technologies that may enhance their quality of life, reduce health complications, and increase independence with mobility and activities of daily living. 

A Triumph for Accessibility 

For individuals living with spinal cord injury, personal exoskeletons offer newfound freedom and independence. The Ekso Indego Personal is modular, lightweight, and portable, making it the ideal solution for use in the home and the community. While many individuals with spinal cord injury typically navigate their environment using a wheelchair, Ekso Indego Personal allows for opportunities to stand at eye-level with their peers, all while walking at the fastest speed currently possible with an exoskeleton. This can profoundly impact a person’s physical and emotional well-being, as well as their ability to complete daily activities. For example, washing dishes while sitting in a wheelchair can result in water running down one’s arms, whereas completing this task in standing is less messy. 

Until now, access to Ekso Indego Personal has been limited to select adults who are Veterans or covered under Workers Compensation insurance. For Medicare beneficiaries, this placed a considerable financial burden on those who could benefit from an exoskeleton for home use. However, with the recent finalization of reimbursement guidelines, Medicare has officially recognized the medical necessity of these devices, opening the door to expanded access for eligible beneficiaries. Physicians and Physical Therapists will play a vital role in identifying, evaluating, and screening eligible individuals to ensure the Ekso Indego Personal will be safe and effective for them. 

Navigating Medicare Reimbursement 

While the finalization of reimbursement guidelines is undoubtedly a step in the right direction, navigating the Medicare reimbursement process can still be daunting for many. To ensure smooth access to personal exoskeletons, individuals and healthcare providers should take the following steps: 

1. Consult with your Healthcare Providers: Discuss the potential benefits of Ekso Indego with your healthcare provider to determine medical necessity and eligibility criteria. 

1. Evaluation and Trial: A trained clinician will work with you to trial the Ekso Indego to make sure it fits and works for you. 

1. Documentation and Authorization: Work closely with your healthcare team and Ekso Bionics to gather necessary medical documentation and obtain authorization for coverage from Medicare. 

The finalization of Medicare reimbursement for personal exoskeletons represents a monumental victory for individuals with spinal cord injury and underscores the importance of inclusive healthcare policies. By recognizing the medical necessity of these transformative devices, Medicare has taken a significant step towards improving accessibility and enhancing the quality of life for thousands of Americans. Ekso Bionics is proud to have played a part in advocating for this coverage and we applaud the Centers for Medicare and Medicaid Services for this decision.  

Want to learn more? If you are interested in pursuing an Ekso Indego Personal for yourself or someone you know, please visit our Ekso Indego Personal page or contact us here.