Exoskeletons - Great advance or expensive waste
We personally look on the emergence of exoskeleton technology in rehabilitation as a great advance but - as we are fond of saying at Anatomical Concepts - there are no perfect products. We realise that this technology is in it's infancy, it's too expensive for the majority and some clinicians doubt that it is cost-effective compared with other rehabilitation systems. However, there is a great need for investment in rehabilitation and everyday we meet individuals who see their quality of life limited by access to effective therapy and technology. We want to see development of effective exoskeleton technology and ethical sales of these systems based on a realistic presentation of the state of the art.
The importance of an assessment
Inevitably, when it comes to potential personal usage of exoskeletons, some devices on the market will be a better match to an individual than others. A first class assessment is always needed that takes on board the users physical/medical status, the performance characteristics of the exoskeleton of choice and of course the life-style expectations of the individual. Our assessments for the Indego are carried out at either the Royal Buckinghamshire Hospital or the Wellington Hospital and typically consist of a 4 hour experience which not only verifies that an Indego would be safe to use but allows the potential user to grasp how the device could fit into their lives.
For rehabilitation clinic usage, there will again be differing views on the best commercial option but some consideration should be given to the expected case mix and the adaptability of the various products.
We are really delighted to represent the Indego from Parker Hannifin in the UK and Ireland. It's a great system but of course we don't pretend it's perfect. Any potential personal user should try out each of the systems on the market and weigh up the pros and cons of each system. For personal usage the Indego compares very well with it's competitors. It is not the cheapest but we think it has the best mix of features and benefits
- It is the lightest on the market at 12 kg (the Rewalk is 30 Kg for example)
- It has a modular structure so it strips down into 5 pieces that fit in a bag
- You can put it on in your own wheelchair - much better than trying to transfer into a device
- Can be worn in a car
- Adjustable assistance levels (0 - 100%) ensure the system can be used effectively by the widest range of users
- An App allows Users to change their own settings if appropriate
One activity that is not supported by the Indego at present is stair climbing. The Indego could physically be used to climb stairs in the same manner as its competitors but at present it is not considered an effective or safe activity so approval has not been sought for this from the regulatory authorities. With the systems that are being used for stair climbing you could question how practical this activity is as it is an extremely slow method - understandably with safety first considerations. Maybe better to take a lift at this stage of development.
Training for home use
In partnership with the Royal Buckinghamshire Hospital or the Wellington Hospital, our clients purchasing an Indego will train for some 40 hours so that we know they will be safe and equipped to get the most out of the Indego. We have seen other exoskeleton systems lying unused in the homes of individuals. This is not a situation we like to see as it undermines the reputation for this approach and reduces the confidence we all need to invest in further developments in this area.
For use in a Rehabilitation Clinic there are some significant advantages of adopting the Indego
In addition to the weight and modular construction mentioned above, the user's foot is in contact with an AFO which fits inside the shoe; this adds up to reduced worries about slipping on uneven or wet surfaces. There are no backpack, shoulder straps or other encumberances but the system can provide sufficient lateral trunk support should the user need this. The Indego allows the assistance levels to be manually adjusted at each joint during different phases of gait. This is different from the Ekso Bionics system, for example, which automatically or manually allows adjustment of assistance in one whole leg or both whole legs.
We think one of the best recent innovations is the availability of two software suites within the Indego. Motion+ for rehabiliation or home usage and Therapy+ for rehabilitation
The new Therapy+ software is perfect for rehabilitation clinics who are dealing with clients who have restorative potential. With Therapy+, the Indego can be programmed to take a step controlled by volitional movements of the user with fully adjustable levels of assistance. The steps do not have to follow a fixed, pre-determined pattern. The features are exciting
- Gravity reduction - Indego can decrease the weight of the users whole leg; allowing the user to move more easily
- Active Swing - Indego actively assists with the swing phase of gait - you can vary the level of assistance provided at the knee and hip
- Stance Support - The risk of knee buckling or hyperextension is reduced by the introduction of active stance phase assistance at the knee
- Auditory feedback - Indego provides users with auditory cues reagrding their step length and symmetry. This biofeedback technique greatly accelerates the user's learning process
The features for the personal user are not static either. Shortly, Parker will release the Advanced Gait function. This function is for advanced Indego Users and allows them to walk significantly faster with a smoother, more physiological gait pattern. We envisage this being used in both rehabilitation centres and for personal usage following some additional training. We are also looking forward to the incorporation of FES into the Indego next year. This should further enhance the restorative benefits of the Indego exoskeleton.