Exoskeleton is One Small Step

Exoskeleton technology used to be the stuff of science fiction; now it’s helping people with spinal cord injuries walk again

WORDS Heather Millar
May 2017

Illustration by Serge Seidlitz

Four years ago, Gary Linfoot stood up and looked his wife in the eye. 

“I forgot how tall you are,” she said. 

This apparently throwaway comment actually marked a watershed for the couple. Prior to this moment, Linfoot hadn’t stood up in four years, since a combat accident in Iraq had left him without sensation from the stomach down. That night, at the American Airlines Sky Ball, an annual military fundraising event, he rose to his full height thanks to an “exoskeleton,” a robotic system of supports and motors that affords the paralyzed newfound mobility.

“That was impressive,” says Linfoot, 48, of his first steps in the system designed by Ekso Bionics, of Richmond, California. Linfoot eventually took home the Ekso system to participate in a year-long trial to test its safety and medical benefits. 

The field is promising: A recent study found that combining a lower limb exoskeleton, virtual reality equipment and brain-controlled robotic actuators in a 12-month rehab program could do what was once thought impossible: The system helped improve sensation and voluntary motor control, reversing the effects of spinal injuries. That coup followed a high profile stunt at the 2014 FIFA World Cup in Rio, in which a paralyzed 29-year-old Brazilian kicked a soccer ball with the help of a brain-controlled exoskeleton.

“I’m a big believer in neuroplasticity,” says Frank Hyland, a physical therapist, referring to the idea that the central nervous system can reorganize itself and form new neural connections. Hyland, who directs the Good Shepherd Rehabilitation Network in Allentown, Pennsylvania, has acquired several Ekso exoskeletons to use in its physical therapy programs. “We’ve found that one of the most important things is to simulate biomechanical movement over and over. We use the Ekso as a tool to jumpstart neuroplasticity.”

Hyland says that in the four years that his hospital has used the exoskeleton, approximately two-thirds of patients with incomplete spinal cord injuries have been able to progress to walking with braces, and some with no help at all. 

The idea of mechanically enhancing physical ability is not new: In 1890, a Russian inventor filed a patent for a spring-powered exoskeleton. The concept has fired our collective imagination ever since, inspiring Sigourney Weaver’s battles with the extraterrestrial villain in the 1986 movie Aliens, the pumped up military suit in the 2009 movie Avatar and Tony Stark’s Iron Man suit in any number of Marvel comics adventures.

Until recently, however, exoskeletons were too unwieldy (a 1960s military design weighed 1,500 pounds) and too power hungry to be fully viable, requiring a tether to a wall socket or a backpack gasoline engine. Then, in 2004, a team at the University of California, Berkeley designed a system that did not need to use power at rest, recharging via kinetic energy as the device moved. That resulted in the first battery-
powered, mobile exoskeleton. The Berkeley team founded Ekso the next year. 

Today, more than three dozen companies around the world are designing these robotic systems for a variety of uses: allowing soldiers to carry large amounts of gear, say, or aiding assembly workers in doing quick, repetitive tasks, or helping manual workers manipulate heavy tools or crouch for long periods of time.

Most of these exoskeletons do not encompass the whole body, à la Iron Man. They’re designed to augment a specific area, most commonly the lower body. An analysis of several smaller studies concluded earlier this year that exoskeletons are safe to use. As a result, more and more medical centers are acquiring them for their rehabilitation programs. 

Several firms are vying to create the go-to system to help the wheelchair-bound walk again: HAL by the Japanese company Cyberdyne, the Israeli ReWalk, HANK by Spain’s Gogoa, Canada’s Arke, Italy’s Kinetek, as well as Indego, SuitX and the Ekso GT by American companies. Indego, Ekso, Indego and ReWalk have won approval from the FDA.

Cost is an issue, however. A ReWalk suit retails at $77,000 and an Ekso comes in at about $100,000. SuitX, another spin-off of the UC Berkeley researchers, offers a “cheap” exoskeleton for around $40,000. Even this, though, is way more than most can afford.

Matt Ficarra, 32, broke his neck in a 2011 boating accident and was temporarily provided with an Ekso suit to help regain feeling in his lower body and manage his pain. Ficarra, who lives near Syracuse, New York, says he’d love to have his own exoskeleton. “To be able to stand up and be free, that was a game changer,” he says. “It’s too bad they’re so expensive. I can’t afford one.”

Linfoot, the injured Army pilot, did receive a personal Ekso system for participating in an FDA trial. He says that it takes about 10 to 15 minutes to put on the exoskeleton, and that the machine doesn’t do well on uneven surfaces with an incline of more than three degrees. The Ekso, says Linfoot, is only a therapeutic device and he still uses his wheelchair as his primary mode of transportation. Still, when his daughter got married in October, he was able to walk her down the aisle. “After my injury,” he says, “I never dreamed I’d be able to do something like that.” 


Russian Nicholas Yagn patents his spring-powered Apparatus for Facilitating Walking, Running, and Jumping
General Electric introduces its hydraulic Hardiman Suit, whose power was matched by its unwieldiness
The Belgrade-based Mihailo Pupin Institute tests its groundbreaking pneumatic exoskeleton for paraplegics 
Retired Army Ranger Monty Reed, paralyzed by a parachute accident, starts work on his Lifesuit exoskeleton

The Kanagawa Institute of Technology starts work on its Power Assist Suit, designed to help nurses lift disabled patients

Scientists are exploring how nanotechnology will help to create devices that are incorporated into a patient’s body, such as “spinal bridges”


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