Putting on the Indego. Credit: Parker Hannifin Corporation/Flickr.

Indego is the result of 10 years of development by engineers at Vanderbilt University, funded by the National Institute of Child Health and Human Development. In 2012 it was licensed to Parker Hannifin (recently renamed to just Parker) for commercialization and marketing. It is an external skeleton that works by strapping it around the patient’s torso, legs are also strapped with supports from the hips to the knees and from the knees to the feet. Computer-controlled motors act as knee and hip joints. Patients use forearm crutches to keep their balance.

Ekso test pilot and ambassador. Credit Ekso Bionics/Flickr.

The international group of exoskeleton providers with various FDA or CE certifications is growing and currently includes: Ekso in the US; Cyberdyne in the EU and Japan; ExoAtlet from Russia; and Israel’s ReWalk. Other providers are in the process of getting approvals or developing commercial versions of their products, that includes:

• Italy’s Wearable Robotics Kinetek
• Canada’s Bionik Labs’ ARKE
• US Bionics’ SuitX
• Rise Robotics’ Exosuit (also from the US)
• Thailand’s Medico Robotics Powersuit
• Switzerland’s Noonee chairless chair
• France’s Wandercraft
• Spain’s Technaid Exo-H2
• and the UK’s REX Bionics’ mobility device.

Many of these startups are seeking insurance policy and coverage from the related healthcare insurers and agencies in addition to CE and FDA approvals for their devices. Japan’s Health Ministry approved Cyberdyne’s HAL exo suit as a medical device that enables it to be paid by the public health insurance system. Cyberdyne has announced plans to submit a request to the health ministry to make this possible.

Insurance coverage

FDA and CE approvals help insurance review boards rule regarding whether to cover exoskeletons. ReWalk was the first in the US to receive workman’s compensation coverage after multiple challenges and reviews. But general health insurance coverage has been slow to approve these new devices either for personal use or even for rehab sessions prescribed by a doctor.

Source: ReWalk

In February of this year, in what could be a major turning point for people with spinal cord injuries, a medical review board ruled that a health insurance provider is obligated to provide coverage and reimbursement for a $69,500 ReWalk robotic exoskeleton. The unnamed health plan initially denied coverage, but after an independent review board dug into the beneficiary’s case and the current state of exoskeleton technology it ruled that the exoskeleton was “medically necessary.”

The review board determined that the exoskeleton was necessary because it allowed the patient to walk. This ruling implies that walking is not a luxury for patients with spinal injuries, but a right—and that if the technology exists and is mechanically sound, insurance companies must cover them.

ReWalk CEO Larry Jasinski was pleased by the decision stating in a press release:

“Health benefit providers have historically been hesitant to acknowledge the clinical benefits in their case assessments. This ruling, and subsequent coverage and reimbursement, will help ReWalk in our efforts to facilitate greater patient access to the device.”

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Rehabilitative robotics company Ekso Bionics announced today that it has completed a public offering which will provide $20.6 million in a ‘reverse merger’. Funds raised will go primarily to expanding sales, while paying off $2.5 million in venture debt and continuing research and development.

The latest announcement comes only weeks after Ekso Bionics debuted a new generation of robotic exoskeletons. The Ekso GT is an exoskeleton which enables individuals with lower extremeity paralysis or weakness to stand and walk. The GT also improves the clinician’s experience, making it easier to provide a range of rehabilitative services.

“This is our fourth product in the evolution of Ekso technology in less than two years, demonstrating not only how quickly the technology is advancing, but how rapidly the clinical community is adopting it into their rehab programs,” said Ekso Bionics chief executive officer, Nathan Harding. “We’re witnessing an exciting new approach to neurorehabilitation.”

The first Ekso GT was delivered to top ranking rehabilitation hospital, the Rehabilitation Institute of Chicago (RIC). This is their second Ekso and is being used to study post-stroke gait training and rehabilitation under an NIDRR grant.

“The results we’ve seen using the previous Ekso among our stroke and spinal cord injured patients have demonstrated we have every reason to embrace and explore this technology further,” said RIC’s vice president, research, W.Zev Rymer, MD PhD. RIC and Ekso Bionics will collaborate and share data under a recently signed research agreement.

“Ekso Bionics was founded to design and develop the world’s most innovative solutions for augmenting human capabilities. in 2012 we delivered our first robotic exoskeleton to the rehabilitation community, achieving the remarkable ability to help people living with spinal cord injuries to stand and walk again,” said Nathan Harding. “This financing, led with investments from Opaleye L.P. and Montrose Capital Partners, represents an exciting milestone in our Company’s history by providing the capital to expand our technology even further and drive adoption in the neuro-rehabilitation market.”

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See all the latest robotics news on Robohub, or sign up for our weekly newsletter.

X1 (NASA, IHMC)

Built in conjunction with the Florida Institute for Human and Machine Cognition (IHMC), the X1 Robotic Exoskeleton weighs 57-pounds and has ten joints, four of which are motorized. However, while the X1 can work to augment the wearer’s movements, it can also be set to work against them. While X1 is still in the research and development stage, it is more likely to join other exoskeletons in use on Earth, like those from Ekso, Rex, Raytheon, Cyberdyne, Honda, MIT, and DARPA projects, than it is to assist humans in space. [Release 12-239 NASA]

Ekso (Ekso Bionics)

The Ekso supports its own 20-kilogram weight via the skeletal legs and footrests and takes care of the calculations needed for each step. In a later model the walking sticks will have motion sensors that communicate with the legs, allowing the user to take complete control. Ekso Bionics initially developed systems for use by able bodied people, starting with the ExoHiker in 2005 and then the HULC, or Human Universal Load Carrier, which was licensed to Lockheed Martin for military development. For more, have a look at Automaton 2012.

HAL 5 (Cyberdyne)

Full hospital trials of the HAL 5 suit from Cyberdyne began this year and are expected to conclude by 2015, although you can currently rent one for approx $2000/month. The Hybrid Assistive Limb (HAL 5) is capable of boosting the wearer’s strength 5 to 10 fold and more than 300 have been leased to a range of facilities in Japan. [The Australian]

Rex (Rex Bionics)

Rex Bionics founder, Richard Little was inspired to work on exoskeletons in 2003 when a friend was diagnosed with multiple sclerosis. The carbon fibre Rex costs about $150,000 NZ and weighs 38k but can give movement, including the ability to climb stairs, back to paraplegics like British TV presenter Sophie Morgan and BBC correspondant, Frank Gardner. [HeraldSun]

SARCOS (Raytheon)
Back in 2000 US Agency DARPA requested design proposals for “Powered Military Exoskeletons” and subsequently awarded Raytheon robotics branch SARCOS with the grant.

The result was the XOS Exoskeleton. It is powered by a single combustion engine which in turn powers the exoskeleton’s servo motors. At 68 kg (150 pounds) the bionic suit is very heavy – but reportedly allows its user to lift 90kg (about 200 pound) payloads “repeatedly with minimal strain”.

The project’s initial goal was an exoskeleton for logistics and supply tasks, but it’s easy to see various possible customizations for combat (e.g., transport and use of heavy weaponry) or battlefield operations (e.g., transport of wounded soldiers).

Others
There are a number of other exoskeletons, including perhaps this robotic wheelchair from Chiba Institute of Technology. Where is the dividing line between an exoskeleton and a vehicle?

Andra Keay from San Francisco and Markus Waibel from Zurich contributed to this post.

If you liked this article, you may also be interested in:

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• Activelink Power Loader gives HAL some competition, but who’s going to Fukushima?

See all the latest robotics news on Robohub, or sign up for our weekly newsletter.