Potsdam, Germany. “It’s a nice feeling to be upright, to walk and to have people at eye level,” said a beaming Peter Kossmehl at the Potsdam Rehabilitation Center in Germany. The 40-year-old from the German state of Brandenburg had just taken a spin in a bionic exoskeleton — a wearable, battery-powered robot — that enables paraplegics to take a few steps again.
The rehab center is one of the first facilities in Europe to test the robot, called Ekso and made by Ekso Bionics. The California-based company introduced Ekso in the fall of 2011.
Now it is to be tested worldwide on paraplegics, stroke and multiple sclerosis patients and other people with lower-extremity paralysis or weakness. Further development for home use is planned as well.
“In Germany, only patients in Aachen have tested the robot Ekso so far a few weeks ago,” said company spokesman Bastian Schink. After them, eight people in Potsdam strapped on and tried out the approximately 23-kilogram exoskeleton. With the help of sensors in its foot units, weight shifts are converted into steps.
“I’d like to give my patients the opportunity to stand erect again as soon as possible,” said Bettina Quentin, director of physiotherapy at the rehab center south of Berlin. “I’m mainly interested in whether the technology can help affected people in their everyday lives.” But Quentin, like many experts, warns against excessive expectations.
“People who function well with their wheelchair will always be faster in them than with the exoskeleton,” said Jan Schwab, head of spinal cord injury research at the Charite University Hospital’s Department of Experimental Neurology in Berlin. “The psychological benefits of a patient standing upright shouldn’t be underestimated, though.” The reactions of the Potsdam patients appeared to confirm this.
“It’s a nice feeling to stand,” said Andreas Klitzsch, 54, the joy of walking again written all over his face. At the same time, he expressed the desire for a substantial improvement in the technology.
“I’m not walking by myself,” he remarked. “It’s only passive walking.” Kossmehl, too, thinks more development work is needed. “But it’s just the right aid for the rehab center,” he said.
In the view of Ruediger Rupp, director of the Department of Experimental Neurorehabilitation in the Paraplegiology Clinic at Heidelberg University Hospital, the robot is not suitable for all patients.
There are about 60,000 paraplegics in Germany, “of whom fewer than 10 percent are candidates [for the robot],” he said. “That’s a very select group.” Someone who can hardly move his or her torso, for example, would have great difficulties with the robot.
Various technologies are meant to make disabled people more mobile. Electrostimulation is one of them, but stimulated walking is unstable. This is why experts have a high opinion of bionic exoskeletons, which were first developed for military use. A soldier wearing one could theoretically carry a 100-kilogram load with no health risk.
Companies around the world are working on models for walking aids, such as Israel, Japan and New Zealand and the United States, where Ekso has been in use at 10 rehabilitation centers since late 2011; clinics in Denmark, Spain and Switzerland are also testing it.
One of the unknowns being examined is whether the device has positive health effects. It could potentially prevent pressure sores, boost blood flow, protect against osteoporosis and keep joints flexible. It could also make disabled people more independent.
“Patients could rehab at home and wouldn’t be bound to the center,” Schwab said. But the device would have to become affordable. It currently costs about 120,000 euros ($150,000).
“It’s going to get less expensive,” remarked Schink, who said Ekso Bionics was aiming for a price between 50,000 and 60,000 euros. “In the coming 12 to 18 months, it will be shipped only to clinics in order to conduct studies,” he said, explaining the company wanted to be sure that the device has doctors’ support.
This, Rupp said, is the proper procedure. “After all,” he noted, “it’s still unclear if there’s possible long-term harm.”