Indego Exoskeleton in the Clinic
Great results in rehabilitation are not produced by accident. Knowledge based on experience, technology, processes of applying that technology and intense commitment all have to come together. If one piece of the puzzle is missing then the results will not be so good. Im excited at the introduction of exoskeleton systems like the Indego into the rehabilitation clinic but we have to remember that no technology alone will transform results for patients - we need to place the technology into an environment where it can be used effectively.
When these systems first arrived in the UK there was understandable excitement and perhaps unrealistic expectations of wondrous events to come. In these kind of situations optimism transforms into skepticism all too easily.
I have heard clinicians with no practical experience of these devices refer to them as just "mobile standing frames". Others are almost unrealistically enthusiastic advocates. As we learn more about the pros (and cons) of neural plasticity and how exoskeletons might encourage restoration of function, I sense some of these attitudes are shifting. However It is entirely reasonable to ask whether investment in these devices is cost-effective compared with other choices of technology that might produce a health gain.
The Indego, we believe, is showing itself to be a strong contender for incorporation into the rehabilitation clinic. This is partly because of the physical structure of the device itself, which is the lightest on the market and pretty easy to doff and don due to its modular structure, but also because of the software available now.
The first generation Indego exoskeletons shipped with MOTION+ software which is ideal for situations when perhaps initially the exoskeleton is to do all of the work. Then over time perhaps the amount of assistance given to the patient can be reduced in step with the degree of functional recovery that is achieved.
MOTION+ was originally designed for persons with significant paralysis in their trunk and legs, such as those with motor complete SCI or very weak AIS C individuals. Within MOTION+, Indego operates like a “legged Segway”. You could argue that some of these individuals could use a Tek RMD very happily in their home environment.
However we now have THERAPY+ software available. THERAPY+, was designed specifically for rehabilitation use for persons with lower extremity weakness. This ideal for patients that are strong enough to at least initiate stepping, such as those recovering from a stroke or SCI or MS with significant muscle preservation on one or both legs (i.e. a person with strong AIS C SCI). To walk forward, the User simply initiates the step, and Indego will assist as much or as little as is necessary.
Clare Hartigan from the Shepherd Centre published a great article on the differences between THERAPY+ and MOTION+ software. We think it adds up to the most powerful tool we have to amplify the recovery of ambulatory function when this is a possibility. The problem of conventional orthotic devices was always that ignorer to provide support to stand we greatly increased the energy expenditure involved in movement and actually contributed to further deterioration in the patient's health status. Exoskeleton devices like the Indego equipped with THERAPY+ software can be considered as restorative devices.
In the UK, our partners the Royal Buckinghamshire Hospital and the Wellington Hospital are applying the Indego with all the ingredients necessary to optimise rehabilitation.