Exoskeletons in Rehabilitation – Great Advance or Expensive Waste?
For any Rehab Centre, Hospital or Clinic investing in an exoskeleton there is a huge amount to consider. Can the system help us meet the therapy goals of our clients? Are the therapists motivated to use these devices in rehabilitation – and do they have the time and resources to do so? Are the senior management on board to support training, special programmes, etc to get the most from the investment? Are there research gaps that could help or hinder a funding application? Do the clients even want to use them?
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.
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. Inevitably some devices on the market will be a better match to an individual than others, but in a clinical setting we believe the Indego offers significant benefits for clinicians working across a broad client base.
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
- The user's foot is in contact with an AFO which fits inside the shoe allowing them to navigate uneven surfaces
- There are no backpacks, straps or encumberances but the system can provide lateral trunk support for those who need it.
- 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
- It can be used with a variety of stability aids depending on the user’s ability / preference
Then things start to get interesting…
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+ and Therapy+
Motion+ is ideal for patients who have very weak or no active leg muscles. This software will allow the client to walk following a pre-determined path, with adjustable levels of assistance.
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 regarding their step length and symmetry. This biofeedback technique greatly accelerates the user's learning process
Shortly, Parker will also release the Advanced Gait function. This function is for experienced 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.
These advances open up the usability and efficacy of the Indego to a much broader client base. When you are able to use the exoskeleton in a personalized way with more clients and produce measureable outcomes, surely that’s a good investment?
So if you’ve been considering adopting exoskeleton technology in your rehab centre there are some noteworthy advantages to the Indego that you might want to see for yourself.
For more information or to arrange a visit for your therapy team visit anatomicalconcepts.com