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.
Physical therapy has evolved so much over the last century. From the early 1900s, when it was used to treat injured soldiers, to today, where there is a myriad of emerging rehabilitation technologies. Exoskeleton rehabilitation in physical therapy is a rapidly evolving field that offers hope for people with disabilities or injuries who are seeking to regain mobility and independence. Exoskeletons augment or enhance the physical capabilities of the user and have the potential to transform the way we approach rehabilitation. But, how effective are exoskeletons in helping people recover from injuries or disabilities? In this article, we will explore the current state of research on exoskeleton rehabilitation in physical therapy and consider the potential benefits.
What is An Exoskeleton, and How do Exoskeletons Work?
An exoskeleton is a wearable technology that is designed to augment or enhance the physical capabilities of the user. It is typically a metallic/carbon suit that is worn on the outside of the body and provides additional support or strength to the wearer.
Exoskeletons were first developed by General Electric in the 1960s, with funding from the United States Department of Defense, as a way to enable humans to lift heavy objects. [1] In the 1980s, scientists began to explore the use of exoskeletons for military purposes, giving soldiers additional protection and abilities during warfare. [2] Today, exoskeletons are being used in rehabilitation to help people recovering from injuries to stand and walk. [3] They are also being used in other industries like agriculture, construction, and manufacturing to help with repetitive manual tasks and reduce fatigue and pain in the back, neck, and shoulders. [4]
Exoskeletons typically consist of a series of interconnected joints and motors that are powered by a battery or other power source. They may also include sensors and control systems that enable the user to control the exoskeleton and adjust its movements. Some exoskeletons also include features such as haptic feedback, which can provide the user with tactile sensations to enhance their sense of touch and proprioception.
There are several different types of exoskeletons, each designed for specific purposes and applications. Lower limb exoskeletons are designed to be worn on the legs and are used to assist with walking or to provide additional support and stability for people who have difficulty standing or walking on their own. Upper limb exoskeletons are designed to be worn on the arms and are used to assist with lifting or other upper body tasks.
Exoskeletons are categorized into the type of power source they use. Some exoskeletons are powered by electricity, either from a battery or from an external power source. Others are powered by hydraulics, using pressurized fluid to move the joints and motors. There are also exoskeletons that utilize other types of power sources, such as pneumatic or mechanical systems.
Active Exoskeletons
An active exoskeleton is a type of exoskeleton that requires the user to provide some form of input or control in order to operate. Active exoskeletons typically use actuators to convert hydraulic, electrical, and air energy into mechanical energy that is used in movement. They also use sensors and control systems to enable the user to control the exoskeleton’s movements. Active exoskeletons may also include feedback systems, such as haptic feedback, to provide the user with information about the exoskeleton’s movements or the environment.
Passive Exoskeletons
Passive exoskeletons, on the other hand, do not require the user to provide any input or control in order to operate. They normally use springs and dampers to store energy generated during movement, which is then reused during motion. Passive exoskeletons are designed to provide support and assistance to the user automatically, without requiring any specific actions from the user. Passive exoskeletons may be used to provide additional stability and support to the user.
Both active and passive exoskeletons have their own advantages and disadvantages, and the choice between them depends on the specific application and the needs of the user. Active exoskeletons tend to be more complex and expensive than passive exoskeletons, but they offer more precise and flexible control for the user. Passive exoskeletons are simpler and cheaper, but they offer less control and may not be as effective in some applications.
Use of Medical Exoskeletons in Healthcare
Medical exoskeletons are designed for use in rehabilitation settings and are designed to help people with lower extremity weakness regain mobility and independence. They work by providing support and assistance to the user’s muscles and joints, allowing them to perform movements that they may not be able to do on their own. They may be used to help people with spinal cord injuries, stroke, or other neurological conditions to walk again. At Ekso Bionics, we primarily design medical exoskeletons that help patients recovering from brain injuries, spinal cord injuries, stroke, and Multiple Sclerosis walk again.
Medical exoskeletons may be used in a variety of settings, including hospitals, rehabilitation centers, and the user’s home. They may be used in conjunction with other physical and occupational therapy strategies to help patients regain their strength and mobility.
There is a growing body of research showing the effectiveness of exoskeletons in medical rehabilitation. Studies show that exoskeletons can improve walking speed, balance, and endurance in patients recovering from different conditions.
Effectiveness of Medical Exoskeletons
Enables Ambulation
Patients recovering from injuries normally have a hard time walking without assistance. They typically need help from their physical therapist and assistive devices to move around. But with the use of exoskeletons, they can walk for longer periods of time to strengthen their muscles. In a 2021 study investigating the effect of robotic exoskeletons on ambulation, researchers reported that patients who trained using exoskeletons in addition to a conventional standard care treatment walked twice the distance (more number of steps) as patients who only received the standard care treatment. [5]
In a randomized control trial studying the effect of exoskeletons on non-ambulatory patients, researchers reported that patients who trained using an exoskeleton walked more steps than those who received usual care. “The Ekso group walked an average of 592 steps per session while the usual care group walked 330 steps.” [6]
Improves Gait
Gait rehabilitation is one of the main focuses in physical therapy, and exoskeletons have demonstrated a lot of potential in improving gait. In a 2020 study investigating gait changes after exoskeleton training, researchers concluded that functional and neuromechanical improvements were achieved after four weeks of gait training. It goes on to say that “there could be potential long-term effects of improved loading and unloading, increased step length, and increased speed due to RE gait training.” [7]
Improves Balance
Balance is an important consideration in rehabilitation as balance deficiencies hugely limit activities of daily living. While there aren’t a lot of studies in this area, the few studies that have been conducted show a positive correlation with the use of exoskeletons in balance training. In a 2019 study investigating the effects of an Ekso Bionics exoskeleton on balance, researchers reported that exoskeleton rehabilitation showed a significant impact on balance in patients recovering from a stroke. [8] In a recent 2021 study, researchers reported that exoskeletons improved balance in patients affected by Multiple Sclerosis. [9]
Reduces Hospital Costs
Using exoskeletons in your rehabilitation center might help you manage your running costs. Following a budget impact analysis of exoskeletons, research shows that exoskeletons reduce locomotor training costs by $1,114 to $4,784 per year when used in 10% of annual locomotor training sessions. [10] These savings could be diverted to other departments or recouped back into the profits of the clinic.
Improves Quality of Life
Exoskeletons can lead to an increased quality of life for patients recovering from different injuries. This was demonstrated in a 2022 study that investigated the effect of exoskeleton training on the quality of life after two months. The researchers of this study reported that the training helped with pain, bladder management, and increased quality of life. [11] The use of exoskeletons also results in psychological benefits as patients can engage with each other at eye-level contact. [12]
Helps Attain Required Therapy Hours
In the US, patients in acute rehabilitation are required to get at least three hours of therapy five days every week. However, this is becoming increasingly difficult to meet due to the reduced availability of rehabilitation services. The pressure on the system is too much, but exoskeletons can help with this dilemma. Pam Lanter, PT, DPT, NCS, Manager of Rehabilitation Services at UH St. John says, “In just one session with the [exoskeleton], we’re able to accomplish what may have taken 5-10 sessions without it.” [13]
Reduces the Burden of Therapy on Therapists
Exoskeletons are also useful for physical therapists too. They help reduce the risk of workplace injuries and exhaustion. This results in better service delivery since you can take care of patients without fatigue. This assertion was confirmed in a 2021 study investigating the efficacy of exoskeleton rehabilitation for spinal cord rehabilitation. [14]
Improves Emotional Well-Being
Apart from physiological benefits, exoskeletons are also linked to psychological benefits. When Alex, who is recovering from a spinal cord injury he got while tobogganing, was asked about his exoskeleton rehabilitation sessions, he said, “It was amazing to be walking again. It really did a lot for my mental and emotional well-being, not to mention the huge health benefit of being vertical. I remember the first time standing up. This gave me something fun and exciting to look forward to every week in a time when I was dealing with a great deal of loss.” [15] Exoskeletons can give patients hope for the future and also increase their engagement and participation in rehabilitation. [16]
Helps Reduce Injury-Related Complications
Patients can develop secondary complications from their injuries due to prolonged sitting. Because of their decreased ability to walk, patients are at risk of developing osteoporosis, bone fractures, pressure sores, and blood clots. Medical exoskeletons benefit these patients by enabling them to stand and move their legs when they otherwise could not, helping to decrease these risks. Dr. Chester Ho, associate professor in the University of Calgary Department of Clinical Neurosciences and member of the Hotchkiss Brain Institute says, “exoskeletons may potentially promote recovery and reduce complications in spinal cord injury (SCI) patients by reducing loss of bone and muscle mass caused by spending so much time lying down, and also improve breathing and bowel function.” [15]
Conclusion
Exoskeletons are still a relatively new technology, and more research is needed to fully understand their potential and to determine the best ways to use them in rehabilitation settings. However, their benefits are undeniable. If you are looking for great exoskeletons for your clinic, feel free to check out our FDA-approved EksoNR.
We combine clinical and engineering expertise to create innovative robotics for rehabilitation centers. Our exoskeletons can be used in therapy by patients who are recovering from stroke, brain injury, spinal cord injury, or Multiple Sclerosis to regain the ability to walk. Contact us today to learn more about our products.
Effects of Exoskeleton Gait Training on Balance, Load Distribution, and Functional Status in Stroke: A Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/32010039/
It is impossible to ignore the number of people affected by spinal cord and brain injuries and the need for new rehabilitation solutions. Each year more than seventeen thousand people in America are affected by spinal cord injuries, and about 1.5 million are affected by brain injuries. [1] As a result, 1 in 50 people in America, or nearly 5.4 million individuals, live with paralysis. [2]
Medical exoskeletons have been making waves in the healthcare industry, offering new hope for individuals with spinal cord and brain injuries. This industry has grown significantly in recent years, reaching a size of approximately $480 million in 2019, and is projected to reach $11.4 billion by 2027. [3] These wearable devices provide support to the body and can help patients regain mobility and independence. In this article, we delve into the impact of medical exoskeletons on both patients and physical therapists, exploring the ways in which these devices are revolutionizing rehabilitation and changing the lives of those affected by debilitating injuries.
What are Exoskeletons?
An exoskeleton is a wearable device that is designed to augment the strength and mobility of the human body. It is typically worn on the outside of the body and consists of a series of rigid frames or shells that are attached to the body using straps or other types of support. Some exoskeletons are powered by motors or hydraulics, while others rely on the user’s muscles to move.
Exoskeletons can be classified into two main categories: passive and active. Passive exoskeletons do not have any power source of their own and rely on the user’s muscle power to move. Active exoskeletons, on the other hand, have a power source and can assist or augment the user’s movements.
Exoskeletons are used in a variety of applications, including medical rehabilitation. Medical exoskeletons are designed to assist individuals with mobility impairments, such as spinal cord injuries or other brain injuries, to walk again. There are several different types of medical exoskeletons available, each of which works in a slightly different way. Some common features of medical exoskeletons include:
Sensors: Many medical exoskeletons have sensors that detect the user’s movements and adjust the device accordingly. For example, sensors may be used to detect when the user is attempting to take a step and provide additional support and power to the leg muscles.
Motors or hydraulics: Some medical exoskeletons have motors or hydraulics that provide additional power and support to the user’s muscles.
Control systems: Most medical exoskeletons have a control system that allows the user to operate the device. This may be a handheld controller or a computer interface that the user can use to adjust the device’s settings and control its movements.
Support structures: Medical exoskeletons often have support structures, such as frames or shells, that are attached to the body using straps or other types of support. These structures help to distribute the weight of the device and provide additional support to the user.
Overall, medical exoskeletons work by detecting the user’s movements and providing additional support and power to the muscles as needed. This can help individuals with mobility impairments walk again or perform tasks that may otherwise be difficult or impossible.
Types of Medical Exoskeletons
There are several different types of medical exoskeletons available, each of which is designed for a specific type of injury or application. [4] Some common types of medical exoskeletons include:
Lower limb exoskeletons: These devices are designed to assist with walking and are typically worn on the legs and feet. They may have sensors that detect the user’s movements and provide additional power and support to the leg muscles as needed.
Upper limb exoskeletons: These devices are designed to assist with upper body movements and are typically worn on the arms and shoulders. They may have sensors that detect the user’s movements and provide additional power and support to the arm muscles to help the user lift or carry objects.
Hybrid exoskeletons: These devices combine features of both lower limb and upper limb exoskeletons, providing support for both the legs and arms. They may be used to assist with walking and upper body movements.
Medical exoskeletons are typically used in rehabilitation settings, such as hospitals or physical therapy clinics. Physical therapists may work with patients to adjust the settings on the exoskeleton and guide patients through exercises and activities to help them regain strength and mobility.
In addition to assisting with mobility, medical exoskeletons may also have other benefits for patients. For example, they may help to improve muscle strength, reduce spasticity, and prevent pressure sores. They may also have psychological benefits, such as increasing the patient’s confidence and independence.
Impact of Exoskeletons on Patients
Improves Muscle Strength and Spasticity:
Patients who are recovering from brain injuries including strokes usually tend to have reduced muscle strength in their legs. They are also likely to experience muscle stiffness and pain as a result of damage to specific areas of the brain. This is a common occurrence because leg muscles atrophy as a result of lack of use.
Physical therapy can help in this case, and in a 2021 study, research showed that exoskeletons could improve grip strength, quadriceps strength, and lower limb motor function. [5] Another 2019 study showed that exoskeletons significantly improved muscle strength and reduced spasticity. [6] In a 2020 study investigating the impact of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients, researchers concluded that exoskeletons have the potential to improve muscle strength and lower limb motor function. [7]
Improves Gait:
Gait training is a physical therapy technique that involves practicing walking patterns with the aim of improving mobility. It is often used to help people who have difficulty walking due to neurological conditions, such as stroke or cerebral palsy, or due to injuries or surgeries that have affected their ability to walk.
According to research, exoskeletons are effective in gait training as they are calibrated to help the wearer achieve natural gait. They also offer more gait repetitions compared to traditional rehabilitation methods. According to one study, “By the end of the training, the gait pattern of the patients improved and came closer to a healthy subject’s gait pattern.” [8]
Exoskeletons like EksoNR have built-in features that help regulate and observe leg movement to promote gait development and help patients balance, squat, weight shift, and even step in place before walking.
Improves Quality of Life:
Beyond the physical benefits of exoskeletons, they also have the ability to enhance the patient’s life. It helps them to do things that they were not able to do before. For instance, it helps patients (even those with severe injuries) to exercise in an upright position. [5]
In some cases, it also gives patients the ability to walk. Physical therapist Kyle McIntosh says, “The exoskeleton lets patients take actual steps, which is not only more realistic but much less cumbersome,” McIntosh also says, “Every step is different with this device, so patients learn from their mistakes in real time. Patients really like to use the device; it gives them hope.” [9]
Helps with Bladder and Bowel Function:
Exoskeletons come with other associated benefits, like improved bowel function. Researchers propose that the upright postures and physical activities that patients engage in while in exoskeletons play an important role in bowel motility. [10] In a 2019 study, researchers concluded that “patients who gained the ability to stand and walk with an exoskeleton often developed better endurance, improved their bowel and bladder control, and were less likely to develop urinary tract infections.” [11]
Boosts Patient Moods:
According to patient feedback, exoskeletons offer hope and motivate patients to participate in their recovery journey. According to a 2021 study, patients’ moods were reported to have improved during the rehabilitation phase. There was also a decrease in fatigue and an improved quality of life. [5]
Other patients also cherish the ability to have eye-to-eye conversations with other people while wearing the exoskeletons. Additionally, since exoskeletons are a “new” invention, more patients are excited to try them out, which increases engagement levels. [11]
Patient Success Stories as a Result of Exoskeleton Rehabilitation
Megan’s Story
Megan’s life took a turn in December 2015 when she had a stroke in her spinal cord. In 2016, she underwent a resectioning procedure, after which she was diagnosed with a T-12- incomplete spinal cord injury (iSCI). After her injury, Megan relied on a wheelchair to move around, but with hard work and physical therapy, she moved from a wheelchair to a wheeled walker to a cane and ankle foot orthoses (AFO). This was a huge win because her doctors had told her she would always depend on a wheelchair for movement.
Megan was still unsatisfied with her progress; in 2017, she learned about Ekso Bionics. While looking for rehabilitation help, she came across a study that wanted to compare Ekso rehab with traditional rehab for patients with incomplete spinal cord injuries. Megan signed up for the study and started participating in the trial in 2018. She was using Ekso for three days per week for 12 weeks, and by the twentieth session, Megan was walking without any assistance. And by the thirty-six session, she had achieved her recovery goal: golfing.
In 2019, Kylie was in a coma. She had suffered an acquired brain injury plus multiple internal injuries. Once she regained consciousness, she began physical therapy, where she was able to attain incredible levels of self-initiated movement while using the EksoNR.
Her physical therapist, Erin, shared, “In the first session, we took maybe ten steps. And now she’s walking over 1,200 steps.” This recovery journey is considered massive for patients who are recovering from ABI. Read Kylie’s full recovery story.
Kathy’s Story
Kathy was diagnosed with Multiple Sclerosis more than 20 years ago, and her symptoms have worsened over time. She got a chance to participate in a research study assessing the effectiveness of the EksoGT exoskeleton in MS rehabilitation, and when interviewed, she said, “My walking speed has increased, my endurance has improved, my gait is more normal and I get intermittent periods of my leg getting signals from my brain.” Read more about Kathy’s exoskeleton rehabilitation story and the research study.
Impact of Exoskeletons on Physical Therapists
Reduces Physical Burden on Physical Therapists
Traditional physical rehabilitation methods are labor-intensive and require a hands-on approach from therapists. This exposes them to work injuries and exhaustion. In a traditional setting, a patient may require two or three physical therapists to manually guide their limbs which can be unsafe. [12] Exoskeletons reduce the number of therapists needed to attend to a patient and minimizes exposure to injuries. This can help physical therapists offer better care to patients without being limited by fatigue.
Reduces Hospital Costs
Exoskeletons can help physical therapists reduce clinical costs. According to a 2020 budget impact analysis of exoskeletons, exoskeletons reduced locomotor training costs by between $1,114 and $4,784 per year when used in 10% of annual locomotor training sessions. [13] This is a considerable amount of money when you consider the long-term implications.
What Other Physical Therapists Think About Exoskeleton Use
“We’re finding that patients are progressing far beyond what we’ve ever been able to get them to because we have this means to get people up earlier.” – Dr. Christina Kwasnica, MD, Medical Director, Barrow Neurological Institute.
“From my own experience, either therapists are physically carrying these patients across the gym at great expense to their own bodies, or they’re just not able to mobilize these patients; so many of our patients are very weak, and therapists absorb much because of the burden. The therapists I work with are now able to do so much more using Ekso.” – Dr. Craig DiTommaso, MD, FAAPMR Medical Director, Kindred Rehabilitation Hospital Northeast Houston.
“Ekso, if qualified, is a more efficient intervention than the body-weight supported treadmill that we do for ABI patients. In terms of logistical manpower, the control of the quality of the gait pattern and repetition for motor learning. I do think that Ekso is a good intervention for early mobilization, tapping into neuroplasticity expediently and more successfully. – Edward Cruz, PT, DPT, Physical Therapist, University of Texas Southwestern Medical Center.
“We went from taking 20 steps with three physical therapists to taking hundreds of steps in a session with one.” – Diane Patzer, DPT Physical Therapist, Rehabilitation Institute Of Michigan.
“We were able to see immediate impact on the patient’s ability to perform bed mobility, transfers, and independence with all functional activities after one session with the device. This device has greatly improved our patient’s outcomes while decreasing physical assistance required by staff members.”- Duncan Monger. PT, DPT, CBIS, Regional One Health Inpatient Rehabilitation Hospital
Conclusion
In conclusion, medical exoskeletons have a positive impact on both patients and physical therapists. For patients, these devices provide support and assistance with mobility, allowing them to perform daily activities with greater ease and independence. For physical therapists, exoskeletons serve as useful tools for rehabilitation and training while lowering costs. More research is needed to fully understand the long-term effects of using medical exoskeletons. However, the bottom line remains that exoskeletons will continue improving and becoming a bigger and bigger part of physical therapy.
For the last 10+ years, we have been developing technology that helps patients walk again. Our efforts have yielded great results with happy physical therapists and satisfied patients. Our FDA-approved exoskeletons are used in over 400 centers worldwide to help patients who are recovering from stroke, brain injury, spinal cord injury, or Multiple Sclerosis. Contact us today to make an inquiry or learn more about our products.
Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity – PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868817/
According to the World Health Organization, rehabilitation is “a set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environments” (WHO, 2011). Drawing from this definition, neurological rehabilitation is a program that helps patients with neurological conditions recover or increase functionality within their environment. Neurological rehabilitation is important as it improves independence, increases the quality of life, and manages symptoms. Neurological rehabilitation programs are customized to the individual and differ depending on the areas affected by the condition.
How Does Neurorehabilitation Work?
Rehabilitation, in general, is primarily rooted in “neuroplasticity.” Neuroplasticity is the ability of the brain to adapt its activity in response to internal and external stimuli. This may include structural and functional changes. It may also involve changes in neural connections. Neuroplasticity allows the brain to learn new things and adapt to new situations, especially after injuries like stroke or traumatic brain injury (TBI). You see, the brain is not “fixed.” It changes with every experience and impression, meaning that new connections are continuously being formed as we continue learning. This learning and relearning quality is what drives rehabilitation.
The goal of every neurorehabilitation program is to restore health, independence, and functionality as much as possible using the best rehabilitation strategies. While the approach used differs from patient to patient, the steps in the process are very similar. The first step of every program is a comprehensive assessment using specific tests to understand the extent of the injury and the patient’s abilities. These tests are then used to create a treatment plan and are also used to set realistic rehabilitation goals. Once the assessment is complete, rehabilitation begins and continues until the desired results are achieved.
Phases of Neurological Rehabilitation
The neurorehabilitation process is made up of different phases, which are based on the severity of the injury and the patient’s symptoms. Each phase is measured using the Barthel Index (a measure of performance in activities of daily living). The treatment a patient receives is based on the stage they are in within the rehabilitation process.
Long-Term Acute Care Hospital (LTACH): This is the first level of critical care after inpatient hospital stays. In this phase, patients require intense clinician supervision and management. It normally involves vent management, tracheostomy care, and wound infection care.
Acute Rehab: In this phase, patients are required to participate in three hours of skilled therapy (PT, OT, speech & language therapy) per day. This is the biggest distinguishing factor between acute rehab and subacute rehabilitation. This phase normally involves shorter stays with the goal of transitioning to home therapy or subacute rehabilitation.
Subacute Rehabilitation in Skilled Nursing Facilities: In this stage, patients are stable but not independent enough to be in the home setting. They are taken through therapy but are not required to fulfill the rigorous therapy demands of acute rehab. There is less oversight in this stage, with one nurse being assigned to many patients.
Long-Term Care Facility or Nursing Home: Nursing home care is for patients who aren’t able to receive the necessary care they need at home. These patients require more supervision and help with activities of daily living like eating, bathing, dressing, etc. They do not require thorough care but may require medication management from nurses.
Home with services: Patients in this phase are more functional and have more independence compared to patients in the other phases. At the same time, they do have home health aids as required.
Conditions That Can Benefit From Neurological Rehabilitation
Rehabilitation may be beneficial for neurological conditions like:
Structural or neuromuscular disorders, such as Bell’s palsy, cervical spondylosis, carpal tunnel syndrome, brain or spinal cord tumors, peripheral neuropathy, muscular dystrophy, myasthenia gravis, and Guillain-Barré syndrome
Functional disorders like headache, seizure disorder, dizziness, and neuralgia
Brain Infections like polio, meningitis, brain abscesses, and encephalitis.
Neurodegenerative diseases like multiple sclerosis, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and Huntington’s disease.
What Does a Neurological Rehabilitation Program Consist Of?
Neurorehabilitation programs are multifaceted and are made up of multiple activities that are customized to a patient based on their condition. Some of the most common activities in neurological rehabilitation programs include:
Help with activities of daily living (ADLs), such as eating, housekeeping, bathing, writing, cooking, and dressing.
Stress and depression management techniques.
Pain management.
Speech therapy to help with speaking, reading, writing, or swallowing.
Help with obtaining assistive mobility devices that promote independence.
Bladder and bowel control retraining.
Nutritional management and counseling.
Mobility activities like muscle control, spasticity management, gait training, range of motion, balance, and coordination.
Cognitive improvement activities that help with problems such as concentration, attention, memory, and poor judgment.
Social and behavioral skills retraining.
Patient and caregiver education and counseling.
Participation in community support activities.
Vocational counseling.
Who Is a Part of a Neurological Rehabilitation Team?
For successful outcomes, neurological rehabilitation teams are multidisciplinary and are made up of different specialists. It is important to note that the rehabilitation team only provides specialized therapy and is different from the patient’s primary care team. Neurorehabilitation teams may include any or all of the following specialists:
Neuropsychologists – These are specialists who treat patients with cognitive and/or behavioral issues related to brain injury, stroke, or other illnesses. They also work with patients who need help coping and adjusting to changes in their physical capabilities. Neuropsychologists may recommend other treatments like cognitive therapy and stress management.
Physical therapists – Physical therapists mainly deal with mobility challenges, like range of motion, balance, pain, gait impairment, and coordination. The main goal of physical therapists is to help patients recover mobility.
Occupational therapists – They are normally involved in helping patients recover their ability to function normally and independently carry out their activities of daily living. They help patients perform activities like dressing, eating, bathing, etc.
Speech-language pathologists – In case a patient’s speech is impaired, speech-language pathologists help them recover their speaking skills. Loss of speech is common among those who have had a stroke, brain injury, or other changes to the nervous system. Speech-language pathologists also work with patients who have difficulty swallowing.
Therapeutic Recreation Specialists – These are certified professionals who provide recreational, therapeutic services like swimming, art therapy, and music therapy, among others. They create recreation-centered medical programs for the patient’s emotional, social, and physical well-being.
Aims of Neurological Rehabilitation
To prevent complications
Neurological conditions may lead to more complications if left unchecked. The complications can cause a deterioration of the conditions themselves or even be life-threatening in some instances. Secondary complications can also interfere with recovery and curtail rehabilitation. Enrolling in rehabilitation helps prevent these complications and also helps specialists identify them before they become a problem.
To teach adaptive strategies
One of the main roles of rehabilitation is to teach patients how to function normally and enable them to perform activities of daily living despite their condition. Physical therapists normally assess the patient’s impairment and develop plans on how to help the patient function in their usual environment. Physical therapists may also create strategies to reduce disability.
To facilitate function in a normal environment
Sometimes, patients are unable to attain premorbid function, necessitating the need for family caregivers and community-based service providers after being discharged from the hospital. Rehabilitation is great for teaching patients and caregivers how to live with new changes, as it can take a lot of mental and physical energy to adapt.
Approaches to Neurological Rehabilitation
There are a variety of techniques that are used in neurological rehabilitation. They include:
Bobath approach: Also known as neuro-developmental treatment (NDT), this technique focuses on attempting movement patterns with a physical therapist’s help. This approach relies on motor learning, and the movement patterns are repeated until each component is perfect. Another emerging technique that leans on movement patterns is robotic exoskeletons. According to a 2020 study, they provide a high dose of repetition of movement while improving balance and stability. [1]
Brunnstrom approach: This technique is a popular movement therapy approach that is used to improve functional movement. It uses a synergic pattern of muscular movements to promote recovery.
Carr and Shepherd approach: This method is all about functional movements. It involves performing and practicing movements repeatedly and correctly until the desired outcome is achieved.
Gait re-education: A lot of patients suffer from gait deficiencies after injury, hence the need for gait rehabilitation. A physical therapist normally identifies and corrects any variations that are present during walking. Exoskeletons, which are an emerging technique in gait rehabilitation, can automatically train gait, which reduces a physical therapist’s involvement. They lead to “increased dosing of gait training without increasing the duration of training during acute stroke rehabilitation.” This is important because it helps patients increase their training intensity without additional therapy time. [1]
Transfer rehabilitation: This method is specifically helpful for patients who are still in the early stages of recovery. It teaches them the techniques they need to perform transfers. For instance, bed-to-chair transfers. The transfer movements are practiced until the patient can confidently perform them.
Mobility rehabilitation: This is a huge part of any rehabilitation program, and it involves developing ways for a patient to move around independently and safely. It involves exercises like balance exercises, range of motion exercises, and stretches — all of which are intended to help a patient recover their mobility skills.
Contracture management: Patients tend to have tight muscles and normally need help releasing the strain in their lower limbs for proper recovery. Some of the common contracture management strategies used include: splinting, weight bearing, and casting.
Equipment and adaptations assessment: After an injury, assistive mobility devices like wheelchairs and walkers may be recommended to facilitate independence. Physical therapists normally provide these recommendations during the rehabilitation process. Read more about mobility devices that are recommended for patients recovering from a stroke.
Conclusion
Neurological rehabilitation is an integral part of recovery that cannot be done alone. With the help of family, friends, community, and the medical team, patients can recover from their injuries and learn how to reintegrate into society.
Ekso Bionics is committed to creating rehabilitation exoskeleton technology that helps patients walk again, and in the last ten years, our efforts have led to thousands of happy patients and physical therapists. Ekso Bionics has a global footprint, with our medical exoskeletons being used in over 400 centers worldwide. If you’d like to learn more or talk to us, visit our contact page, and we’ll get in touch with you shortly.
We are honored to share an incredible story about our Patient Ambassador, Tarek Rasouli from Munich, Germany.
In the 1990´s, Tarek Rasouli was one of the best professional BMX and mountain bikers in the world. That had always been his goal. At the age of 9, Tarek would ride with his BMX bike and race with his friends at the Olympia park in Munich, with the intention to become the fastest on the BMX track in his age group. Driven by passion and ambition, he became a pro. He was the only European in the legendary Froride crew – the first pro free rider team of the bike brand Rocky Mountain. Tarek put all of his time and energy into being a pro athlete.
In 1999, at the age of 24, Tarek decided to quit BMXing and switch 100% to mountain biking. He joined the Rocky Mountain Freeride Team in the beginning of 2000. But instead of racing or just doing magazine shoots, he wanted to make it into bike movies.
In 2002, Tarek joined the production for the fifth Kranked movie in British Colombia, Canada. At that time, BC was the place to be, where standards were set in the world of mountain bike freeriding. The Kranked series was the benchmark for a professional mountain bike freeride athlete. Tarek had made an appearance in the fourth movie, which had positively impacted his career, so he was excited to head to Canada to film the fifth movie.
They were filming at Sun Peaks, a ski resort that had partnered with the film for one of its segments. After reviewing a few locations, builders began working on creating jumps within a snowboard halfpipe that was made of dirt for the summer. After filming at another location, Tarek and his friend and colleague, Johnny, went over to the halfpipe to check it out and trial it. Tarek was excited to try the jumps first, but he didn’t take enough time and didn’t check his speed in the run in. He overshot the landing and made a split-second, mid-air decision to let go of his bike. He fell from about 20 feet onto his feet. The impact broke his right heel and the first lumbar vertebra, which is in the lower section of the spinal column. He was instantly paralyzed from the waist down.
Foto Philipp Horak fuer Redbulletin
Maerz 2021
Muenchen
Tarek Rasouli
Despite the tragic incident, Tarek stayed in the bike industry and followed the opportunity to organize events. He co-founded the company “Rasoulution,” an event and sports management company. The company organized mega-events like the RedBull District Ride, while also becoming the most valuable mountain bike athlete-management house there is. With riders like Danny MacAskill, Fabio Wibmer, Emil Johansson, Erik Fedko, and many more, Tarek has quickly made a name for himself once again.
In 2020, former motocross professional Hannes Kimnigadner invited Tarek to visit his rehabilitation sessions. Hannes had also been in an accident and had walked with Ekso several times. Tarek went for the visit and gave Ekso a try. The first time, he says he was very overwhelmed, but he wanted to try again.
Tarek initially used Ekso once per week but has since increased to two or even three times weekly of walking. He notes changes and progress in different areas from using the Ekso. Initially, he noted feeling changes in his glute muscles and low back. Prior to using Ekso, he reported having regular problems with his neck, but since initiating Ekso therapy, these problems have disappeared. Tarek says he feels “in general stronger to endure a long day in the wheelchair” noting that this increased endurance has helped his busy work life.
When asked how it feels to use Ekso, Tarek says “it just feels good, but it is also tiring, but in a positive way.” He now recommends Ekso to others in order to help them stay healthy and live long, happy lives post injury.
In 2021, Tarek joined the Wings for Life World Run wearing Ekso, which produced a lot of media attention. He says his life is now busier then ever, but still finds time to use his handbike either outdoors or inside on a trainer. In October 2022, Tarek was inducted in the Mountain Bike Hall of Fame in Fairfax, California.
At Ekso Bionics, we are proud to support incredible athletes like Tarek and help them regain mobility and endurance. If you’d like to learn how Ekso could benefit you, please connect with us for more information.
According to the U.S. Pain Foundation, about 50 million people experience pain daily. [1] A survey conducted by the Centers for Disease Control reports that 20.4% of adults experience chronic pain, and about 7.5% experience pain that’s so severe that it frequently interferes with their work or life. [2] This calls for an effective pain management solution. Enter physical therapy. Physical therapy isn’t just about mobility recovery and recovering from injuries. Physical therapy plays an important role in the management and treatment of pain too. And with the looming opioid crisis, it’s a highly recommended alternative as it has no side effects and is a more sustainable treatment method for patients with chronic pain.
How Does Pain Relief Through Physical Therapy Work?
Physical therapy goes beyond treating pain. It identifies the source of pain in the body and treats it from the point of origin. The body is an interconnected system that works through different forces and pressure points. Nerves and blood vessels are attached to all organs and musculoskeletal structures in the body. Nerve pain in one area could be the result of muscle compression in a different area of the body. Resolving the strain in that specific muscle group could help restore fluidity, make the area limber, and reduce pain. Physical therapy restores balance and flexibility to ensure that blood vessels and nerves are not hindered.
Is Physical Therapy a Better Pain Management Strategy?
Due to the opioid epidemic, alternative pain management solutions are a growing concern among the medical community. Opioids are known to cause severe side effects among patients suffering from chronic pain, the biggest ones being abuse and addiction. According to the National Institute on Drug Abuse, about 10.1 million people misused opioids in 2019. [3] Tamara Dangerfield, MPT, a physical therapist with the University of Utah Health, says, “Taking a pill may seem like a great option for people when they hurt and just want the pain to go away, but we have seen huge detrimental effects on people who have come to rely solely on opioids for pain control. Opioids are only effective at treating these types of pain for short periods of time and in long-term situations become less and less effective with huge risks and side effects.” [4]
“The prevalence of chronic pain and the increasing use of opioids—which have led to addiction and fatalities — have led to increased efforts to address chronic pain in other ways,” explains Ben Gilbert, PT, MS, MBA, OCS, Cert. MDT, Director, Outpatient Rehabilitation, Main Campus at Burke Rehabilitation Hospital. [5] The biggest alternative method to reduce opioid dependence is physical therapy. It is normally recommended as a blended approach where patients can get drug support for pain management but are also enrolled in physical rehabilitation facilities that help them manage their pain in a better way. Physical therapy isn’t a one-time shortcut to pain relief. It is the opposite. It relieves pain over time and is a more long-term solution. This makes it a great solution for patients who want to avoid opioid dependence. According to Tamara, physical therapy is a better choice, especially for patients with prolonged musculoskeletal conditions.
Types of Physical Therapy
There are different types of physical therapy techniques used in managing pain. They are classified into:
Passive physical therapy: In passive treatment techniques, the patient is normally stationary, while therapy treatments are applied to the body to alleviate pain.
Active physical therapy: Active rehabilitation methods involve patient movement and participation and may be more effective for longer periods.
Passive Physical Therapy Treatment Techniques
Heat/cold application – This involves the application of heat and/or cold, which helps reduce muscle spasms and inflammation.
Transcutaneous electrical nerve stimulator (TENS) – This method involves the use of electrodes to deliver a mild electric current in the affected area. The electric impulses send signals to the brain, which stimulate the production of endorphins, a natural painkiller. Electrical nerve stimulation also helps in muscle relaxation, which contributes to pain relief.
Laser therapy – Laser energy is projected into a specific area to accelerate tissue healing and reduce inflammation.
Iontophoresis – This transdermal drug delivery technique uses an electric current to deliver steroids under the skin membrane, which helps reduce pain and inflammation.
Ultrasound – This method uses ultrasound waves to penetrate the soft tissues and reduce muscle tension and pain.
Massage therapy – Massages help relax the muscles, improve blood circulation, and relieve pain.
Active Physical Therapy Treatment Techniques
Range of motion exercises – Range of motion exercises involve the movement of joints to increase flexibility and stretch muscles and other tissues. It’s also great for sensory stimulation. Range of motion exercises can be passive, active, or active-assisted. Exoskeletons may be used for range of motion rehabilitation but splinting is typically the gold standard.
Dynamic lumbar stabilization – After an injury, back muscles weaken and sometimes atrophy, hence the need for dynamic lumbar stabilization exercises. The goal of these exercises is to build back strength, reduce tension and increase flexibility. Exercises may include knee-to-chest stretch and back flexion stretch, which help relieve neck and back pain.
McKenzie approach – These exercises are focused on spine extension and pain alleviation. The exercises move the pain from the legs and arms to the back, which is able to tolerate pain better.
Aquatic exercise – This exercise, as the name suggests, is conducted in a pool. It relies on the water’s buoyancy to relieve pressure from the patient’s body. This allows patients to exercise their neck, back, leg, and shoulder muscles with less pain.
Targeted and general conditioning – This technique involves the use of endurance, stretching, and strengthening exercises to relieve pain in a specific area of the body.
The Importance of Physical Therapy in Pain Management
Little side effects
Physical therapy pain management techniques have little to no side effects. Common approaches like aquatic exercise, range of motion exercise, electrical stimulation, and ultrasound are non-invasive methods and have a low risk of side effects. This, however, cannot be compared to surgery and medication. Pain medication, for instance, can lead to addiction and dependence.
It may surprise you that physical therapy’s side effects are actually positive. They include “improved mood, blood pressure, weight control, bone density, endurance, strength, and sleep.” [4]
Holistic pain management
Physical therapy focuses on treating the root cause of pain instead of temporarily masking the pain. Pain medication temporarily provides relief by covering the pain for a short period of time but doesn’t fix the real issue in the body that is causing the pain. On the other hand, physical therapy identifies where the pain originates and then provides specific treatment strategies to alleviate pain in that specific area of origin.
Physical therapy is customized
Physical therapy regimens are completely customized to fit the patient’s schedule, lifestyle, and recovery goals. Physical therapists create structured individual plans that help manage pain and reduce inflammation while encouraging healing and recovery.
Contributes to improved physical health
Physical therapy is an active process that requires patient participation. In addition to pain alleviation, physical therapy strengthens muscles, tendons, and ligaments, improves range of motion, restores balance, and promotes healing.
Other benefits
It is reported that patients who take up physical therapy to manage their pain normally have lower outpatient and pharmacy costs. They also have lower out-of-pocket medical expenses and are more likely to avoid an opioid prescription. [5]
Conclusion
Physical therapy has a variety of treatment methods available. This means that there is something for everyone. If a patient doesn’t respond to a specific treatment method, your physical therapist will help you try another one until they find the one that gives them their desired results. Patients can also combine several methods and modify their rehabilitation regimen.
Physical therapy is the only risk-free and safe choice that’s focused on long-term pain relief. The medical community advances that it is a better option for patients with long-term musculoskeletal conditions compared to painkillers.
Ekso Bionics is a distinguished exoskeleton manufacturer that creates modern rehabilitation solutions that help patients learn to walk again. Our exoskeletons are used in more than 400 rehabilitation centers globally. Learn more about us or make an inquiry today to learn how you can procure our FDA-approved exoskeletons.
Robotic exoskeletons are not a far-removed idea from our imagination, thanks to pop culture. Exoskeletons have been featured in films like Edge of Tomorrow [1], where Tom Cruise’s strength is augmented using a combat jacket [2], Marvel’s Iron Man [3], where Tony Stark’s abilities are amplified using AI and mechanics, and Avatar [4] where the AMP suit [5] is used to navigate Pandora. And now, they are no longer just part of science fiction but are a part of our reality. In 2014, Julian Pinto, who is completely paralyzed in his lower extremities, made history by kicking off the World Cup in Brazil with a robotic exoskeleton that was created by a team of more than 150 researchers. [6]
The robotic exoskeleton industry is experiencing a boom as more use cases are developed in new industries, and experts predict it will be worth $1.8 billion by 2025. [7] This article will cover everything you need to know about exoskeletons, including interesting little-known facts about exoskeletons.
What is an Exoskeleton?
An exoskeleton is a wearable device or a suit that works alongside the user to enhance their strength and amplify their performance. It is usually worn on the body. Exoskeletons use a combination of robotics and biomechatronics to enable body independence and are designed to provide support rather than replace functionality. In physical rehabilitation, they help patients relearn skills. In construction, they reduce the amount of energy expended and make repetitive tasks easier. And in the military, they are used to help soldiers carry heavier loads over longer distances.
The first exoskeleton-like device was invented by a Russian inventor known as Nicholas Yagn in 1890. It had a spring-operated design that was intended to be used by the military to run and jump, but it didn’t make it to production. However, that was just the beginning of what would later become a growing industry. In 1960 General Electric created a 1,500-pound exoskeleton called the Hardiman (Human Augmentation Research and Development Investigation). Unfortunately, it was too heavy and large, so the project was shelved. [8]
In 2000, engineers at UC Berkeley, backed by The Defense Advanced Research Projects Agency (DARPA), created a pair of robotic legs that were meant to reduce the energy used in carrying heavy loads over long distances. [9] Finally, there was a successful break into functional exoskeleton designs.
Today, robotic exoskeletons are more diversified and have undergone multiple iterations to create complex and advanced designs with various features and applications. For instance, Ekso Bionics creates exoskeletons used for neurorehabilitation, military research, and industrial uses.
Types and Classifications of Exoskeletons
There are different types and classifications of exoskeletons which depend on the body part where they are worn and how they are powered.
Exoskeleton Classification
Full body – A full body exoskeleton is an exosuit that is used for strength augmentation in the military and rehabilitation.
Upper extremity – An upper-extremity exoskeleton is one that supports the arms and potentially the torso. It can further be broken down into shoulder joints, elbow joints, the wrist, and even fingers.
Lower extremity -This is an exoskeleton that is used to support the legs. It comes in different configurations like hip, knee, or ankle only, hip-knee, knee-ankle, or hip-knee-ankle.
Types of Exoskeletons
Powered exoskeletons
These are exoskeletons that rely on batteries and electric cable connections to work. One great example of a powered exoskeleton is the EksoNR, which uses two sets of long-lasting, rechargeable lithium-ion batteries. Powered exoskeletons are divided into static and dynamic exoskeletons.
Static exoskeletons: These exoskeletons require that the actuators be on at all times in order for the device to run well.
Dynamic exoskeletons: Dynamic exoskeletons do not need actuators to be on, which makes them more energy efficient.
Passive exoskeletons
These exoskeletons do not require electrical power in order to run. They rely on other mechanisms in order to work and are good for:
Weight redistribution: The springs in the exoskeleton plus the locking action redirect an object’s weight into the ground.
Energy capture: ankle spring-clutch exoskeletons may help improve walking efficiency.
Dampening: Some exoskeletons are used as shock absorbers and vibration reducers.
Locking: Some exoskeletons can be locked into place, which allows users to stay in one position for a long time.
Pseudo-passive exoskeletons
These are exoskeletons that have all the features of a powered exoskeleton but do not provide actuation. E.g., the C-brace by Ottobock.
Hybrid exoskeletons
These exoskeletons typically have all the features of a powered exoskeleton but use the input of the muscles as actuators.
9 Interesting Facts About Medical Exoskeletons and Other Exoskeletons
Exoskeleton rehabilitation is one of the best ways for patients with mobility challenges to relearn walking.
Exoskeletons simulate natural gait during rehabilitation which initiates powerful brain signals that thanks to brain plasticity, can help patients recover their ability to walk. Exoskeletons also simulate natural gait by using drives in the hip and knee joints which move the wearer’s legs. Exoskeletons can be used by the patient independently or with the help of a therapist. They contain a predesigned program that helps therapists control the level of speed and power based on the patient’s needs. Exoskeletons can also be customized to an individual by adjusting the size.
Training with exoskeletons positively influences a patient’s mental health.
Patients who train with exoskeletons report improved moods, morale, and mental health after just a few sessions. This can come from the ability to have conversations at eye level with other people. Exoskeletons also give hope to patients who were completely immobilized as they are able to walk again during training.
Standing in vertical positions also has benefits like better blood circulation and lung volume, which contribute to better overall health. Exoskeletons make the training more exciting as they are a far more advanced way of rehabilitation and tend to give patients confidence which can reduce depression and other mental health issues.
Some exoskeleton models can be controlled by the patient’s thoughts.
This is not science fiction, we promise. You see, exoskeletons normally have different types of control systems like buttons, tablets, and smart crutches, which help the patient control the amount of support they receive from the exoskeleton. The most advanced control method in the world today is a brain activity interface that helps the patients actuate the exoskeleton using their thoughts. This allows for improved neural plasticity, which may contribute to the speed of recovery. “Hybrid Assistive Limb (HAL) works by using small sensors on the skin that detect minor electrical signals in a patient’s body,” explains Brooks Rehabilitation director of clinical technology Robert McIver, “As those signals are detected by the robot, it responds with a movement at the joint. It is the only system that I have come across where the patient’s nervous system acts on an external device.” [10]
Other exoskeletons like the EksoNR have touchscreen controls that help clinicians set goals and alter assistance levels for patients of all different functional levels. Physical therapists can also easily access the medical device’s database to analyze complex movement patterns and record patient progress.
Some exoskeletons are made using the same materials as airplanes.
All exoskeletons use different materials in their build. The most common being carbon fiber and metal. Others are made from materials like steel alloys and aluminum which are heavy and rigid. All exoskeleton materials should be strong enough to support patients when in a vertical position.
Exoskeletons are not exclusively for lower limbs.
Did you know that there are different types of exoskeletons? As highlighted above, exoskeletons are divided into full-body, upper-body, and lower-body exoskeletons. Exoskeletons can also cover a specific body part like the hip, knee, elbow, and even finger. Ekso Bionics is continually iterating exoskeleton designs to create more efficient and effective solutions.
Exoskeletons are used in the medical, military, construction, and automotive industries.
There are two types of exoskeletons; medical exoskeletons and industrial exoskeletons. Medical exoskeletons are normally used in rehabilitation to help patients regain mobility, while industrial exoskeletons are used to augment human performance. Industrial exoskeletons are meant to make work easier for the wearer. You can read up on the use of exoskeletons in construction here.
Industrial exoskeletons were first developed in the 1900s when they were used in the military. They have since then found applications in construction, automotive, and agriculture. They are very mainstream, so much so they are considered a part of personal protective equipment (PPE) for some automobile companies like Ford.
Exoskeletons were first featured in pop culture in 1919.
A lot of people tend to think that exoskeletons are a 21st-century idea, but in truth, it was existent even in the 20th century. Exoskeletons were first depicted in The Master Mystery, which is a 1918 American mystery silent film.
Exoskeletons are used in sports.
Apart from medical and industrial applications, exoskeletons have found a new, fun application in the world of sports. As crazy as that sounds, Jonathan Tippett is pioneering an exoskeleton racing sport where racers control a 14 feet tall prosthesis and compete against other players. [11] The prosthesis relies on the leg, arm, hand, and feet movements of the user to move. It is powered by a lithium-ion battery and can run up to 20 mph. This sport is referred to as mechanical racing.
You can use exoskeletons to be supersized.
Fancy having an exosuit that makes you ten times bigger than you already are? Now you can get one. Skeletonics create 10 feet tall exosuits that can turn you into a giant. Without the use of batteries or motors, all joints and limbs, including fingers, can move with precision mechanically. They utilize kinetic energy instead of electricity to power the exoskeletons. [12]
Conclusion
Just when you’ve learned everything there is to know about exoskeletons, a new exoskeleton is developed, or a new use case is created. That’s the beauty of being in the middle of a developing and fast-growing industry. At Ekso Bionics, we aim not just to be the leaders in exoskeleton technology but also to make exoskeletons that help patients regain full mobility.
We always aim to develop disruptive wearable robotics in the medical arena, and so far, we’ve helped thousands of patients with lower extremity disabilities take over 200 million Ekso-aided steps. We are at the forefront of shaping new devices for neurorehabilitation with FDA-cleared exoskeletons for MS, stroke, SCI, and other brain injuries. To learn more about Ekso Bionics, click here.
Stroke, as defined by the World Health Organization, is an accident to the brain that has “rapidly developing clinical signs of focal or global disturbance to cerebral function, with symptoms lasting 24 hours or longer, or leading to death, with no apparent cause other than of vascular origin and includes cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage”. [1]
Stroke is ranked as the 5th leading cause of death worldwide and the leading cause of disability, with a new stroke happening every 40 seconds. [2] In the United States alone, approximately 800,000 people experience a stroke each year, and about two-thirds of this population require rehabilitation to get back to their lives. With the growing need for stroke rehabilitation each year, we aim to break down what stroke rehabilitation entails and highlight some of the modern physical therapy treatment techniques you can incorporate into your stroke rehabilitation program as a physical therapist.
The Effectiveness of Stroke Rehabilitation
Stroke rehabilitation is a program of different therapy techniques put together with the aim of helping a patient relearn lost skills, optimizing how a patient functions, and increasing their level of independence in order to achieve the best quality of life.
Effective stroke rehabilitation requires you to work closely with your patients, altering the different types of therapy depending on their needs and changing the intensity and time of their program based on their progress. Successful stroke rehabilitation depends on:
Physical factors like the severity of the stroke.
Emotional status of the patient, for example, motivation, resilience, persistence, grit, consistency, etc.
Social support, for example, from family and friends.
Curative elements like early rehabilitation and the skills of the stroke rehabilitation team.
These factors have been practically proven to impact the success of rehabilitation in real-world scenarios. In a 2017 randomized control trial, researchers concluded that rehabilitation combined with early supported discharge (ESD) “seems to reduce death and institutional care and to improve patients’ chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward an improved functional outcome in the ESD group.” [3]
One of the important elements of successful rehabilitation that has been proven in neurorehabilitation is focused repetitive practice. It’s the same element we use when learning new skills like writing, playing a musical instrument, or sports. Research shows that functions located in areas of damage are normally moved to other regions of the brain, and carefully directed practice can help in the rewiring of brain circuits in the new areas. [4]
According to research, early rehabilitation is associated with better outcomes, irrespective of the severity of the stroke. Thus, physical therapy should be offered early in the recovery process. In addition, if rehabilitation happens in a different location from acute care, the transition should be seamless. A review by Harutoshi Sakakima et al. alludes to physical exercise being a prototypical precondition stimulus that provides brain protection effects. [5]
There are many treatment methods that can be incorporated into a stroke rehabilitation program, but for this article, we will specifically focus on physical therapy techniques that aid in upper and lower extremity function recovery.
Physical Therapy Treatment Techniques
There are many treatment techniques that can be used in upper limb and lower limb rehabilitation. Therefore, these ideas are not an exhaustive list of what’s available.
Lower Limb Rehabilitation: Gait and Mobility
Gait recovery is a primary goal in any rehabilitation program for patients recovering from stroke and can be achieved using the following interventions:
Body Weight Supported Gait Training: This training method helps a patient control their weight, balance, and posture by using a harness that is mounted from a metal frame or ceiling. It can take place over a treadmill or over the ground. When using a treadmill, the patient is secured using a harness for fall prevention and then set up over a treadmill. Body weight-supported treadmill training provides more control over the ambulation speed, environment, and allows therapists to offer cues for proper gait dynamics.
Therapists can control the effort required by patients during training by weighting or unweighting the patient using the suspension system. Unweighted training reduces the amount of weight borne by the patient and makes the patient feel lighter. This, in effect, makes the patient expend less effort during the training sessions.
Body weight can, however, be added back during training depending on the patient’s progress and abilities. Therapists can also help with stance with swing phases of gait, posture, knee control, heel strike, and limb advancement. Research reports that body weight-supported treadmill training can help improve motor function and balance. Additionally, it helps enhance gait quality compared to traditional gait training methods. [6]
Electromechanical Assisted: Electromechanical-assisted gait training is commonly used as a supplementary training technique for overground training. It’s great for completely immobilized patients as it helps them intensely practice complex gait cycles without overexertion on the therapists part. Robotic exoskeletons are popular in this category as they help increase movement during training while reducing therapists’ burden. They require less manpower for the same mechanical therapy that traditional rehabilitation methods use. Since the exoskeleton does most of the work, the therapist only needs to set the patient up in the device and supervise them. [7]
Apart from increased repetition, exoskeletons can help patients relearn the proper walking technique from the start of the rehabilitation. They also offer other benefits like sensory feedback, weight support, and real-time control and monitoring features. Robotic exoskeletons are also advantageous in helping patients increase their range of motion. [8]
EskoNR is a leading robotic exoskeleton in use in rehabilitation clinics around the world. It is cleared by the Food and Drug Administration for rehabilitation and offers unique features to help patients learn to walk again. It provides different gait training modes that support the knees, ankles, hips, and torso and helps the patient maintain an upright posture. You can use it in the preGait mode or walking mode depending on the recovery level of your patient. The preGait mode contains activities that help prepare patients to take their first steps, like balancing and midline orientation. As a patient progresses in their recovery, the EksoNR reduces the support offered, allowing for more control and stability, eventually leading them to walk without the device.
Rhythm Cueing: Rhythm cueing involves the synchronization of movement to a uniform sound. Rhythmic cues are used to guide movement and influence motor execution, but they don’t have to be strictly rhythmic. According to research, rhythmic cueing can help improve timing in motor tasks that have complex timing and in conditions that affect how an individual perceives time with regard to movement. Having external rhythm can also help by supporting the mechanisms of the brain that are associated with keeping time. [9]
Successful gait training with rhythmic cues requires auditory inputs from different parts of the motor control system like the cerebellum, cerebral cortex, nervous system, and brainstem. Additionally, to achieve success, the gait must be well linked with the acoustic rhythm, and the speed of the metronome must be right. [10]
Overground walking: Overground walking, also known as overground gait training, involves observing a patient’s walking pattern on a solid surface while cueing them to perform different activities that can help improve their gait. This is a simple and easy technique to incorporate into your rehabilitation program as it doesn’t require complex technology and can be done in a variety of locations.
Orthotics: Orthotics deals with the design of custom artificial braces and splinters that can be used to correct, support, or stabilize a body structure. One common type of orthosis used in lower extremity rehabilitation is an ankle foot orthosis. KNGF Clinical Guidelines recommend it for individuals whose mobility is affected by drop foot during the swing phase of walking. [11]
Functional Electrical Stimulation (FES): This is a rehabilitation technique that uses low-energy pulses to activate weak muscles and nerves. Functional electrical stimulation has been in use since 1960. It relies on electrodes to stimulate the relaxation and contraction of muscle groups. One important and interesting thing to note is that it’s the nerves and not the muscles that are stimulated, as they have lower current requirements compared to muscles. Some of the factors that affect how electrical stimulation works include the size of the surrounding tissue and the distance between the nerve fiber and electrode.
FES application in rehabilitation settings is important because it helps promote motor recovery by providing visual and sensory feedback. It also helps avoid disuse atrophy, a common stroke complication resulting in muscle fiber changes. FES can help by correcting the muscle fiber changes by changing the type II glycolytic fibers back to type I oxidative skeletal muscle fibers.
Balance Training: A stroke can cause weakness in one side of the body, leading to balance impairment. Hence the need for balance training and weight-shifting exercises. Researchers reviewed literature published between January 2006 and February 2010 and concluded that balance training is an effective technique for rehabilitating patients with stroke. [12]
Stair Training: Stair training is a great training method for mobility rehabilitation as it helps patients recover their range of motion in slopped environments. In a 2017 study investigating the effects of stair task training on walking ability in stroke patients, thirty-six patients with stroke were selected randomly and divided into two groups: the experimental group and the control group. The study reported that the gait training group that used the 10-cm high stairs showed the biggest improvement in balance and muscle activities compared to the other group. These results conclusively showed that stair training is a viable rehabilitation technique in clinical environments and can be used to improve patients’ walking ability. [13]
In a 2021 randomized controlled study investigating the efficacy of lateral stair walking training in patients with chronic stroke, it was revealed that lateral stair walking improves hip muscle strength and gait in patients. Thus, stair walking can be added to rehabilitation programs to aid gait and balance improvement. [14]
Strength Training: Strength training is a versatile technique that can be used to rehabilitate both the upper and lower extremities. While there isn’t a specific strength training approach for lower extremity rehabilitation, progressive exercise has been shown to help improve muscle strength and is recommended by Australian Stroke Foundation guidelines (2017) and the AHA guidelines (2010). [15] Although resistance training effectively improves strength, there is limited evidence supporting its influence on walking parameters. [15][16] Common strength training exercises used in physical therapy target the quadriceps and hamstrings.
Upper Limb Rehabilitation Practices
Bilateral Arm Training: Bilateral arm training is a form of intensive training that involves performing movement patterns or activities with both hands at the same time but independently of one another. These movements or activities may also be cyclic. This method was created in response to CIMT’s (Constraint Induced Movement Therapy) known drawbacks, which include its inability to allow for the practice of bilateral skills, especially those involved in functional activities that are by their very nature bimanual. Both bilateral and unilateral training have the same positive effects. The severity of upper limb paresis and the timing of the intervention following the stroke, however, may affect the outcome of the intervention.
Constraint-Induced Movement Therapy: The goal of constraint-induced movement therapy (CIMT) is to encourage patients with hemiplegic stroke to practice moving their affected limb while restraining the unaffected limb.
Robot-Assisted Arm Training: Robot-centered training involves the use of mechanical devices to offer active, passive, and resistive limb movement. This method is great for extended treatment periods and can be customized to the needs of the patient by using their movement as feedback. Though there is limited evidence on the use of robot-assisted arm movement, it can be combined with other conventional therapy methods to provide better rehabilitation outcomes. According to a 2018 study, “People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength.” [17]
Strength Training: Strength training is designed to increase muscle strength and endurance. According to research, strength training has the ability to improve strength and function in the upper extremity without increasing pain in patients with stroke. [18] However, the intensity of strength training doesn’t affect outcomes, as shown in a recent study. Common strength training exercises that are commonly used in upper limb training include bridges, tricep dips, weight-bearing leans, tabletop lateral pushing exercises, tabletop forward pushing exercises, and bicep curls. For effective strength training, all the training exercises should be adjusted to the level of the patient’s ability.
Conclusion
All these training methods can be incorporated into a rehabilitation program in different combinations and at different times. The key to maximizing their effectiveness is tailoring them to your patient’s individual needs and abilities. When introduced early, they can help improve results and boost the success rate of your program. Above all, intensive practice is an important factor irrespective of the technique you choose.
Ekso Bionics is a leading medical exoskeleton manufacturer on a mission to help patients learn how to walk again. EksoNR was one of the first FDA-approved medical exoskeletons for stroke rehabilitation. It is the exoskeleton of choice for many physical therapists and is available in rehabilitation clinics around the world. If you would like to procure an exoskeleton for your clinic, contact us by clicking here.
