EXO SKELETON SUITS DESIGNED TO HELP PARAPLEGICS WALK BY JAMES ADAM LASSWELL

PARAPLEGIA VS. QUADRIPLEGIA Paraplegia is the loss of sensation or movement (to some degree) in the lower portions of the body. Quadriplegia is paralysis to some degree in all four limbs. If the injury is below the first thoracic spinal nerve it will result in paraplegia, if it is above that nerve then it is quadriplegia.

DIFFERENT MODELS/COMPANIES Rewalk/Rewalk Robotics (formerly Argo Medical Technologies) Ekso/Ekso Bionics HAL/ Cyberdyne

OVERVIEW/SIMILARITIES An exo-skeleton has five major components: Frame- The foundation for the device, the outside “skeleton” holding the person up Batteries- Lightweight and interchangeable Sensors- Different places depending on model/ receive input from the body to transmit on Controller- The “brain”, it absorbs the information from the sensors and helps move the body Actuators- The “muscles” which physically move the device based on input from the controller

REWALK Composed of metal brace to support legs and upper body; motors to help the hips, knees, and ankles move; tilt sensor that detects motion; and a backpack that powers it. Uses a wireless remote on the wrist to issue commands stand up, sit down, or walk. Does not work for quadriplegics or those without control of their upper body. The only version currently approved by the FDA for home and public use. As of 8/7/15 it cost $77,000 and 66 had purchased it for personal use. The suits weighs around 51lbs, and the user has to be a certain size/weight for current use (between 5’2” and 6’3” and under 220 lbs.)

EKSO Ekso Bionics develop and manufacture powered exoskeleton bionic devices for the military, industrial, and medical field. Like Rewalk, it requires use of the upper body; has a frame on the legs and shoulders; a backpack with the battery/controller; and tilt/motion sensors in the legs. Unlike Rewalk it is not currently for home use and is only used under supervision of a PT. It has many more features that are adjustable by the PT to tailor to the specific user. (These include changing gait, power to different legs, and how much the suit will walk for them) It weighs 45lbs and users must be between 5’2” and 6’4” and less than 220lbs. It costs $130,000 and is only purchased by hospitals/rehabilitation centers.

HAL (Hybrid Assistive Limb) HAL was developed by Japan’s Yoshiyuki Sankai for both medical and industrial purposes. There are two primary versions of the system: HAL 3, which only provides leg function, and HAL 5 which is a full-body exoskeleton for the arms, legs, and torso. When a person moves their body, electric signals are sent from the brain to muscles through the nerves. HAL 3 reads the user’s bio-electric signals(BES) from the surface of their muscles to transmit input on what the suit should do. The HAL 5 also uses this technology, and while it is an upper body model, it currently cannot assist those without upper body movement(quadriplegics). HAL 5 was a multi-purpose design meant not only to help paraplegics, but also for industrial purposes as well. https://www.youtube.com/watch?v=ZsZZYOisbmo (start at 1:07)

IMPACT ON PEOPLE Helps paraplegics physically and emotionally by making themselves more self-dependent. Being stationary can cause  "serious problems with their urinary, respiratory, cardiovascular and digestive systems, as well as getting osteoporosis, pressure sores, blood clots, and other afflictions associated with lack of mobility" (Salisbury, 2012) Using these suits also provides physical benefits as well “ Some of these physical benefits include increased bone density, decrease in body fat percentage, improved cardiovascular, bowel, and bladder function, and improved sitting posture” (ReWalk, 2012) Depending on the severity of the disability, there is a possibility of the user getting strong enough using the device to be able to eventually walk unaided.

LONG TERM PROSPECTS Each of these companies is currently working on making their products more lightweight and affordable to ensure they are an option for anyone who is paraplegic. While medical purposes is currently one of the major functions for exoskeletons, many other uses are being researched/designed. Cyberdyne was propositioned by the U.S. government to research the technology for military purposes, but Sankai refused. There is also a similar technology being developed for quadriplegics which uses a BCI, or brain computer interface, to help those even without upper body functionality to walk. These devices wouldn’t require the user to concentrate on a specific command like “walk”, but perform the act as they normally would by sending nerve signals from the brain to the exoskeleton.

RISKS/DRAWBACKS At this point, the cost of any of these suits is too much for the average consumer. It will be an uphill battle to get insurance companies to cover these devices. There are also those that can’t currently use these because of the weight/height requirements. If exoskeletons did become more widespread there is fear that those that can’t afford it will be left behind. Many cities might stop focusing on providing handicap accessible routes once these new technologies start to spread. If an alternate technology, such as a computer in the brain that could send signals to the extremities, takes off then this could become an outdated/obsolete technology.

Hybrid Assistive Limb (HAL) Purpose/Design Advantages/Disadvantages HAL is a powered exoskeleton suit developed by Yoshiyuki Sankai and his company Cyberdyne. It has been designed to support and expand the physical capabilities of its user, particularly people with physical disabilities. There are two primary versions of the system: HAL 3, which only provides leg function, and HAL 5, which is a full-body exoskeleton fro the arms, legs, and torso. When a person attempts to move their body, nerve signals are sent from the brain to the muscles through the motor neurons, moving the musculoskeletal system. When this happens, small biosignals can be detected on the surface of the skin. The suit registers these signals through a sensor attached to the skin of the wearer. Based on the signals obtained, the power unit moves the joint to support and amplify the wearer’s motion. HAL is designed to assist the disabled and elderly in their daily tasks, but can also be used to support worker with physically demanding jobs such as disaster rescue or construction. Currently, it is mainly used in hospitals by disabled patients to help in their rehabilitation process. Advantages: -Helps paraplegics physically and emotionally by making themselves more self-dependent. -Being stationary for long periods of time can cause further health issues. -Using the suit provides physical benefits such as increased bone density and decrease in body fat percentage. Disadvantage: -At this point, the cost of any of these suits is too much for the average consumer. -It will be an uphill battle to get insurance companies to cover these devices. - If an alternate technology, such as a computer in the brain that could send signals to the extremities, takes off then this could become an outdated/obsolete technology. Specifications The current HAL 5 suits weighs 60lbs,. It is 36 for the lower body, and 34 for the upper body. They are currently not available for purchase in Japan or America, but you can rent them in Japan. However, the price for even one leg is $1,500 a month. They also currently have a 5 hour battery life. They are currently working on improving the battery life and lowering the cost to make it affordable for the average customer. The suit is named after the robot in 2001: A Space Odyssey, and the company Cyberdyne shares the same name as the company that created the Terminators.

References http://www.theatlantic.com/technology/archive/2015/08/exoskeletons-disability-assistive- technology/400667/ http://www.brainandspinalcord.org/spinal-cord-injury/paraplegia-vs-quadriplegia-tetraplegia.html http://www.disabled-world.com/artman/publish/spine_picture.shtml#t1 http://www.livescience.com/47353-robot-exosuit-helps-paralyzed-move.html http://www.eksobionics.com/ekso http://www.thedailybeast.com/articles/2015/08/03/the-mechanical-exoskeleton-shaping-the-future- of-health-care.html http://www.wired.co.uk/news/archive/2010-04/23/brain-controlled-exoskeletons-advance-with- mindwalker http://www.gizmag.com/ucla-robotic-exoskeleton-non-invasive-spinal-cord-stimulation/39216/ https://www.rt.com/usa/169020-fda-approves-rewalk-robotic-suit/ http://www.businessinsider.com/human-exoskeleton-approved-by-fda-2014-6