Exoskeletons are poised to revolutionize rehabilitation therapy. Originally pioneered by General Electric in the 1960s, these wearable machines were first funded by the United States Department of Defense to develop a prototype that would allow humans to lift heavy objects. The concept soon evolved, with others adapting it to create locomotor exoskeletons designed to support the musculoskeletal system, enabling injured or paraplegic individuals to stand and walk.
By the 1980s, researchers began exploring the military applications of exoskeletons to enhance soldiers’ protection and capabilities in combat – an area that continues to develop today. More recently, humanoid robotic technologies have been trialled across various industries, including agriculture, construction, manufacturing, and healthcare, to support workers with repetitive manual tasks. The global market for robotic technologies is expected to grow by 26% over the next five years.
Two Categories of Wearable Machines
Exoskeletons typically fall into two main categories: passive and active.
- Passive exoskeletons use combinations of springs and dampers to store energy generated from human movement and release it when needed to enhance posture or motion.
- Active exoskeletons, in contrast, use actuators – powered by electricity, hydraulics, or compressed air – to produce mechanical force, thereby supporting and augmenting human motion.
Exoskeletons come in a variety of forms, including upper-body, lower-body, or full-body designs. They can be used to:
- Reduce back muscle activity by 10% to 40% during lifting and holding tasks, an application particularly valuable to nurses assisting patients, as it helps protect the spine, back, neck, and shoulder muscles.
- Alleviate arm pain and fatigue experienced by surgeons during laparoscopic procedures, without interfering with the surgical workflow.
Informal carers (family members or loved ones providing hands-on care to individuals who are chronically ill or terminally ill) are another group who could benefit significantly from the physical support offered by exoskeletons.
Clinical Applications in Rehabilitation
Neurology, orthopaedics, and gerontology are among the clinical fields where exoskeletons are increasingly used. They are especially relevant in the treatment of conditions such as spinal cord injury, multiple sclerosis, stroke, and osteoarthritis. For individuals with motor and functional impairments, wearable robotic devices hold substantial promise in delivering more effective rehabilitation, reducing the risk of injury, and increasing the efficiency of care compared to traditional gait training methods.
Addressing Gait Disorders
There is a rising global prevalence of disability-related conditions. According to the World Report on Disability, approximately 15% of the global population lives with some form of motor disability, with around 4% experiencing motor or neuromotor dysfunction. These impairments, ranging from mild to severe, significantly affect functional independence and environmental interaction.
Contributing factors include limited access to conventional or technology-based rehabilitation, poor care coordination, and overburdened healthcare providers. Gait disorders, affecting around 60% of those with neuromuscular conditions, substantially impact quality of life. Immobility often leads to a sedentary lifestyle, increasing the risk of secondary health conditions such as cardiovascular and respiratory complications, bladder and bowel dysfunction, obesity, osteoporosis, and pressure ulcers – all of which can reduce life expectancy.
As a result, restoring the ability to walk is a primary goal in the rehabilitation of individuals with neuromuscular impairments. Robotic gait rehabilitation, introduced around 25 years ago, offers an alternative to conventional manual therapy. It delivers repetitive, intensive, and precisely controlled training in an engaging setting, reducing physical demands on therapists and enabling objective, quantitative assessments of patient progress.
Advancing with AI-Powered Systems
The integration of advanced data acquisition, processing, and control technologies, particularly those based on artificial intelligence, has paved the way for more sophisticated biomechatronic systems, including robotic exoskeletons. These AI-powered control strategies can outperform traditional approaches by:
- Detecting user intent.
- Modulating control schemes in human–robot interactions (also known as arbitration).
- Providing real-time feedback during rehabilitation exercises.
Given the significant variability between and within individuals, AI-based systems are particularly well-suited to managing the complexities of personalized rehabilitation.
Conclusion
The field of wearable exoskeletons has made considerable strides since its emergence two decades ago. nevertheless, ongoing efforts are essential to develop lightweight, user-friendly designs that can be validated through rigorous, standardized protocols to ensure optimal, patient-specific rehabilitation outcomes.
A multidisciplinary approach, combining technological innovation with clinical expertise, is vital. In particular, input from therapists and rehabilitation specialists is crucial for evaluating the effectiveness and appropriateness of robotic rehabilitation devices.
Integrating advanced medical technologies into physical therapy can significantly accelerate recovery compared to traditional therapy alone. Portable, wearable devices are poised to redefine physical rehabilitation, making it essential to encourage their rapid adoption within clinical settings.
Veronique Ropion, MD
Director of Business Strategy, Marketing and Corporate Communication
Source:
- Hohl K. et al. A framework for clinical utilization of robotic exoskeletons in rehabilitation. Journal of NeuroEngineering and Rehabilitation (2022) 19:115 – https://doi.org/10.1186/s12984-022-01083-7
- O’Connor S. Exoskeletons in Nursing and Healthcare: A Bionic Future. Clinical Nursing Research 2021, Vol. 30(8) 1123–1126.
- Rodríguez-Fernández A. et al. Systematic review on wearable lower‑limb exoskeletons for gait training in neuromuscular impairments. J NeuroEngineering Rehabil (2021) 18:22 https://doi.org/10.1186/s12984‑021‑00815‑5
- Vélez-Guerrero MA et al. Artificial Intelligence-Based Wearable Robotic Exoskeletons for Upper Limb Rehabilitation: A Review. Sensors 2021, 21, 2146. https://doi.org/10.3390/s21062146