How Exoskeletons Are Beneficial for Acquired Brain Injuries

Acquired brain injuries (ABI) are more common than we’d like to imagine. According to the Brain Injury Association of America (1), brain injury is a leading cause of death and disability in the U.S., with at least 2.8 million Americans sustaining a traumatic brain injury each year. In the U.K. (2), approximately 348,453 ABI patients were admitted to the hospital in 2017, which translates to one person every 90 seconds. These statistics are not limited to the U.S. and U.K.; a similar pattern is observable in other parts of the world. Despite the bleak outlook from these statistics, modern medical exoskeletons offer hope and an opportunity for recovery from brain injury patients who’ve lost their mobility.

This article investigates the causes, types, and effects of brain injuries. It also looks into the various treatments available with a special focus on medical exoskeletons and how they are improving mobility rehabilitation in ABI patients.

What Is An Acquired Brain Injury?

The Brain Injury Association of America describes an acquired brain injury (ABI) (3) as any injury to the brain that occurs after birth and affects the brain’s physical integrity, functionality, and metabolic activity. In other words, the term ABI is used as an umbrella term for all brain injuries. An acquired brain injury can occur in many different ways. It can be sudden, resulting from a blow to the head, stroke, infection, trauma, or lack of oxygen. It can also result from a long-term process such as degenerative disease, prolonged drug abuse, or a growing tumor. An ABI may lead to cognitive, sensory, physical, and behavioral changes like physical weakness, impaired vision, forgetfulness, mood swings, slurred speech, and impaired mobility.

Major causes of ABI include:

  • Substance abuse – Psychoactive drugs (stimulants, depressants, and hallucinogens) can poison the brain, leading to impairment. 
  • Age-related and degenerative conditions – As we get older, we become more susceptible to degenerative brain conditions like Dementia and Parkinson’s disease, which increase the risk of developing a brain injury.
  • Diseases – Such as meningitis, Alzheimer’s disease, brain abscess, multiple sclerosis, and cancer.
  • Anoxia and Hypoxia – This is the lack of sufficient oxygen supply to the brain. It can result from strangulation, heart attack, or near-drowning.
  • Concussion – This is caused by a blow to the head. It can occur in vehicle or sporting accidents, fights, or falls. It is the most common type of brain injury.
  • Stroke – which happens when there is an interruption of blood supply to the brain. It can be caused by blocked or broken arteries, which in turn leads to damaged brain tissue.

Types and Effects of Acquired Brain Injuries

There are two types of acquired brain injuries: traumatic brain injury (TBI) and non-traumatic brain injury. A traumatic brain injury is any type of brain injury that is caused by an external force—for example, a blow to the head, car accident, or a fall. However, not all head injuries cause a TBI because you can sustain an external impact to the head that doesn’t alter the brain in any way. On the other hand, a non-traumatic brain injury is caused by internal factors like oxygen deprivation, tumors, substance abuse, and strokes. Non-traumatic brain injuries can be sudden, as in the case of a stroke, or can progress over time, as in the case of a degenerative brain disease.

Acquired brain injuries affect people differently based on the extent of damage sustained to the brain and the areas affected. For instance, one type of injury may affect a person’s mobility, while another may affect their speech or cognitive functions.

Here’s a detailed list of the effects of acquired brain damage (4):

Acquired Brain Injury Therapy

A wide range of treatments are available for people with an acquired brain injury ranging from surgery to speech therapy to cognitive therapy and physical therapy. Each treatment is dependent on the effects the patient is experiencing. Generally, all types of treatment are designed to help improve and recover affected functionalities, but recovery differs from person to person. It usually depends on the extent of brain damage, the general health of an individual, and the quality of treatment.

  • Physical therapy: The main function of physical therapy is rebuilding mobility after sustaining an ABI. It focuses on areas like muscular strength, balance, coordination, and flexibility. It is normally conducted by a physiotherapist who is trained in physical mobility restoration. Physical therapy can also be aided by the use of a medical exoskeleton.
  • Occupational therapy: Occupational therapy typically goes hand in hand with physical therapy. Occupational therapy is aimed at helping you relearn daily living activities like bathing, making your bed, dressing, etc. It is conducted by occupational therapists who are experts in training people how to regain independent functioning in daily activities.
  • Cognitive-behavioral therapy (CBT): This addresses the cognitive and behavioral functions that might have been affected after sustaining an ABI. It is common for patients to experience stress, anxiety, depression, and panic attacks during recovery. CBT therapy helps them learn how to manage their emotions by teaching how to identify unhealthy thinking patterns and healthy emotion management techniques.
  • Speech therapy: Speech therapy is a recommended treatment option for people with speech impediments like communication disorders and apraxia. Speech pathologists help patients regain their communication and language skills by taking them through speech recovery exercises.

Exoskeleton Benefits for Acquired Brain Injuries

Medical exoskeletons have gained a lot of popularity in the medical field and are a great physical therapy treatment option. Instances of health-related applications (5) for exoskeletons include stroke, spinal cord injury, acquired and traumatic brain injury. They offer benefits like improved step quality, muscle strength, and postural balance, as discussed below.

  • Improves Patients’ Orientation to Midline

The midline is an imaginary line that runs from the top of your head to the point between your feet. Proper midline orientation (6) means that your brain’s left and right hemispheres are working together and not in isolation. This helps with balance perception when walking and conducting other activities. However, some patients, who have sustained an ABI, may lack proper orientation due to their injury, which leads to reduced limb and motor control, and postural misalignment. Exoskeletons help match both sides of the body through kinesthetic and proprioceptive systems, leading to an improved orientation to the midline.

  • Allows For Easier Weight Shifting

Proper weight shifting allows body weight to be evenly distributed on all limbs. However, this may be impossible for people diagnosed with an ABI.  (7) This is where exoskeletons come in handy. Medical Exoskeletons offer posture and limb support (8) which helps patients bear their own weight properly for proper postural alignment and blood circulation within the limbs.

  • Improves Stepping Quality

According to a 2020 study, (9) conducted on adolescents and young adults with acquired brain injury, gait training with exoskeletons is an effective physiotherapy treatment option that leads to improved motor function in patients. Many patients struggle with ambulation (movement), but with the help of medical exoskeletons, they can increase their neurological recovery through movement. Dr. Karunakaran reported, “At the end of the 4-week training, participants had progressed to a more normal gait pattern, including improved loading, a longer step length, and faster walking speed.” (9)

  • Increases Lower Extremity Muscle Strength

Exoskeletons amplify human strength and endurance during movement, improving muscle strength. One 2020 study (10) on the impact of a lower limb exoskeleton robot on muscle strength showed that patients with stroke hemiplegia, who trained using lower limb exoskeletons, experienced an increase in the tibialis’ anterior muscle strength compared to those who relied on conventional rehabilitation.

  • Great for Repetitive Motions

Repetition in motor rehabilitation is a crucial element of recovery, and exoskeletons provide patients with high repetitions of complex gait cycles. Additionally, where a patient used to only take few steps a day with the help of a physical therapist, they can take more steps with the help of a medical exoskeleton. (8)

  • Provides Support to Physical Therapists 

Physical therapists can only do so much. They are human and prone to fatigue and exhaustion. A 2020 study (11) revealed that stroke patients get an average of 14 minutes of physiotherapy per day, which is less than the recommended threshold. However, exoskeletons have unlimited capacity, and using them reduces the workload for physical therapists and increases the quality of rehabilitation for patients. Exoskeletons allow for increased intensity, longer duration of practice, and increased patient engagement. (12) They also provide a chance for physical therapists to challenge their patients since they require active participation, which is known to improve brain plasticity. (13)

Diane Patzer, a physical therapist from the Rehabilitation Institute of Michigan (8), says, “We went from taking 20 steps with three physical therapists to taking hundreds of steps in a session with one.”


Medical exoskeletons are a great mobility recovery tool to use in physical therapy. They enhance motor rehabilitation by giving patients the confidence to get up and begin walking. They eliminate a patient’s fear of falling, which helps them start their mobility recovery faster. And above all, exoskeletons are very engaging compared to other tools. This makes them a great tool for patients who want to increase their chance of mobility recovery.

Ekso Bionics has been at the center of developing medical exoskeletons for more than a decade. Our products are created by clinical and engineering experts in conjunction with feedback from industry leaders. EksoNR, a product of Ekso Bionics, is the first and only FDA-cleared medical exoskeleton for rehabilitation use with ABI. EksoNR is versatile and can be used by ABI patients at any stage in their recovery journey.








(7) The scaling of postural adjustments during bimanual load-lifting in traumatic brain-injured adults


(9) Kinetic Gait Changes after Robotic Exoskeleton Training in Adolescents and Young Adults with Acquired Brain Injury

(10) Impacts of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients

(11) Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme

(12) Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series

(13) Effects of Physical Exercise on Neuroplasticity and Brain Function: A Systematic Review in Human and Animal Studies

Patient Success Story: Megan

A patient story we would like to share with you features one of our Patient Ambassadors, Megan Burns, from Greater Chicago.

Before her injury, Megan was a healthy active adult in her early thirties. Megan enjoyed playing tennis a few times a week at her neighborhood courts in the summer. On Sundays, Megan would play golf with her partner Brian and her Aunt and Uncle. She also went on daily walks with her dog Chip. Megan and Brian also enjoyed hiking in Lake Geneva on the scenic lake path in the spring, summer, and fall in Wisconsin.

Megan also liked a little adventure. Shortly before her injury she hiked up the Devils Doorway at Devil’s Lake in Wisconsin, enjoyed zip lining down mountains in the Jamaican rainforest, and walked up the 600-foot-long landmark Dunn’s River waterfall. Every May, Megan and her cousin Mindy would go for an adrenaline rush and ride all the big roller coasters at Six Flags Great America; rain or shine!

Megan’s entire life changed in December of 2015 when she had a stroke in her spinal cord caused by a ruptured arteriovenous malformation (AVM). A spinal AVM is a rare, abnormal tangle of blood vessels on, in, or near the spinal cord. Due to the spinal cord stroke, Megan underwent a resectioning of her spinal cord which was performed in February of 2016. After her AVM and resectioning surgery, Megan was diagnosed with a T-12- incomplete spinal cord injury (iSCI).

Post-injury, Megan used a wheelchair to get around. Over time with physical therapy and lots of hard work, she was able to progress to walking with a wheeled walker and eventually a straight cane and AFO (ankle foot orthoses) braces. Doctors were thrilled with this progress since her original prognosis was that she would always need to use a wheelchair. Although the progress was great, Megan did not accept that she had reached the end of her journey towards walking independently. She would rely on her cane for stability and drag her legs through the motions of walking. For Megan, this was not the best solution and was not the peak of her progress!

Megan was introduced to Ekso in the fall of 2017 which was two years after her injury. Still not satisfied with the quality of her gait, she went to the Shirley Ryan AbilityLab website to look for rehabilitation help. Megan saw they were seeking participants for a study called WISE (Walking Improvement for SCI with Exoskeleton) which was looking at comparing Ekso rehab with traditional rehab for incomplete spinal cord injured patients. She fit the study criteria and signed up immediately. Luckily, Megan started as a participant of the trial in the first quarter of 2018. She would end up using Ekso three days per week for twelve weeks and here is what happened next:

First session – Megan found her balance with the help of the preGait functions and her posture began to recover.

Third session – She became very comfortable and confident in the device. Megan learned how to work together with the exoskeleton, that Ekso was not walking for her, and stopped fighting it. At this point she really started to learn from it.

“It was here that I realized I need to take the information I learned in Ekso and carry it over into real life. This is where I realized the importance of Ekso and the steps. I was taking 500+ steps in my first few sessions of 45 minutes each. That was more steps than I was taking in days. Not only was I thrilled at the step quantity, but also the quality. The step pattern in Ekso is natural and would not allow me to drag my toes. You can only take quality steps in the device.”

Fifth session – Together with her therapist, Megan realized she had not used her calves in two years. She finally started pushing with her calves again to clear the toes that were curled under from foot drop. Even today, Megan says, “I still hear my PT when I am walking to PUSH.”

Session twelve – Megan stopped using her AFO because she was engaging her calves with every step. By the twelfth session she was taking 900+ steps in Ekso each time, including backward and forward walking.

By session twenty Megan was walking in the community completely unassisted—no more cane!

And the best news of all, by the thirty-sixth session in Ekso Megan was back to golfing, a goal of hers since her injury back in late 2015.

“Now, in outpatient, my therapists are kind and patient, but also challenge me. MidAmerica Rehabilitation Hospital is now my family.”

Today, Megan still can’t feel her legs from the waist down but has been able to build up her muscles in her legs in order to keep walking.  She has carried on with all the lessons from her Ekso training and has been walking unassisted for nearly two years! She has returned to using Ekso in the outpatient setting, for what she calls “tune ups”.  As a busy professional and someone who travels for pleasure as often as she can, Megan tends to get busy with life moving quickly and returns to some old habits—short steps, not weight-shifting, and dragging her toes.

“Every time I use Ekso I learn something new and take it with me. I do have to think of every step I am going to take, but now it is so much easier.” 

Megan would like to stress how much she believes in Ekso. So much so, that she would drive more than two hours round-trip for the twelve-week duration of the study to get into the device to keep learning to walk. We are so thrilled with Megan’s progress and her incredible return to the full life she was enjoying prior to her injury. Since regaining her balance and strength she has been able to get back to her adventurous side and has been parasailing, scuba diving, cliff jumping, and hiking at the Grand Canyon.  She also has returned to joining friends for concerts and still makes her annual trip to Six Flags to ride the roller coasters with her cousin.

Megan’s success with Ekso has also led to her joining Ekso Bionics as a Patient Ambassador so she can continue to share her story with as many people as possible and spread hope.

5 Amazing Ways to Use Exoskeletons for Construction

Whether you are lifting heavy objects or completing light and repetitive tasks, construction exoskeletons are your best chance of injury prevention and productivity enhancement. In 2017 alone, there were at least 12,000 injuries per month in the construction industry (1), many of which could have been prevented with the use of exoskeletons. According to research (2), exoskeletons reduce human metabolic cost and thermophysiological response during upper-body work tasks, which translates to less fatigue and strain for workers., resulting in increased productivity. For construction and warehouse workers, exoskeletons are the next industrial shift that will lead to increased efficiency and productivity. 

In this article, you will learn what exoskeletons are, how they are applied in construction, and their benefits. Let’s dive in.

What Are Exoskeletons? 

Exoskeletons, also referred to as exosuits, powered-armor, or exo frames, are wearable external frames that offer extra support and enhance a person’s biomechanical capabilities. Think Iron Man from the Avengers, but in real life. The exoskeleton acts as a strength amplifier that augments physical performance or a corrective device for restoring mobility. 

Some people believe that exoskeletons are a new “thing”. However, this technology has been in existence since 1890 but has only gained more traction in recent years due to accelerated technology developments. The early model, designed and patented by Nicholas Yagn (3), was a spring-operated device that enhanced the user’s ability to run and jump. 

Today, exoskeletons have wide applications and are used in the military, medical, and construction fields. In the medical industry, physical therapists use them as locomotive assistance and gait training devices for patients who have a condition or injury that affects mobility. While in the construction industry, they are primarily used to help workers with their upper extremity mobility by reducing strain and increasing productivity. 

There are two types of exoskeletons, powered and passive. A powered exoskeleton contains electric motors, levers, hydraulics, and other technologies that enable limb mobility with increased endurance and strength. It works by sensing the wearer’s motions, sending signals to the motors, and offering the necessary support. A passive exoskeleton differs from a powered exoskeleton because it is purely mechanical. However, they both offer benefits such as shoulder, waist, or thigh support.  Additionally, it offers movement assistance when lifting heavy items. Powered exoskeletons are mostly used in military and physical therapy, while passive exoskeletons are more commonly used in construction and other industrial industries.

Exoskeletons and Injury in the Construction Industry 

Did you know that the rate of work-related musculoskeletal disorders in construction is 16% higher than in all industries combined?(4) This statistic alone should be enough to point you to the most significant challenge that construction workers face: workplace injury. According to the Construction Chartbook (5), the most common injuries in construction are located in the back, shoulders, and other joints. This can be attributed to the long and repetitive tasks that eventually lead to overexertion and strain to workers’ bodies. 

“The most common cause of workplace injuries was overexertion and fatigue. With 20% of construction workers reporting severe pain, construction workers are five times more likely to report poor health. US companies pay nearly $62 billion per year for workplace injuries.” (6)

Workplace injury results in lower productivity, which accumulates to more than 104 million lost production days.(1) In addition, it impacts construction workers’ morale as the uninjured employees have to take up bigger workloads to make up for the injured and recuperating workers. It also affects the injured person’s ability to complete future tasks and lowers their working lifespan.. However, organizations can avoid this by investing in construction exoskeletons. 

In a study conducted in 2015 on the application of exoskeletons in industrial applications and their potential effects on physical workload, researchers discovered that exoskeletons greatly reduce fatigue while improving endurance (7). Additionally, exoskeletons reduce shoulder discomfort, thereby improving work quality and productivity among workers. Apart from decreasing the risk of workplace injury, exoskeletons also assist aging workers, and give them an opportunity to work beyond their age and physical limit.

Construction exoskeletons are the future of the construction industry due to the efficiency and productivity opportunities they present. Their primary purpose being: to improve the quality of life for construction workers and prevent injury. 

You can use exoskeletons on the manufacturing floor to engage in long-intensive overhead work like installing sensors and filters without straining or injuring yourself. Benefits include joint support that’ll boost your endurance, productivity and prevent injury.

The Construction Exoskeleton Vest 

Construction exoskeletons come in different shapes and variations suited to a specific task. Depending on the workload, it can be a full suit, a simple vest to support upper limb mobility or just a glove. Let’s take a look into an exoskeleton vest.

The construction exoskeleton vest is an upper-body exosuit specifically designed to support upper extremity mobility. Its main goal is to reduce workplace injury and worker fatigue by supporting muscle activity and joint movement. It also reduces discomfort when performing repetitive overhead tasks. Let’s establish one important fact; a construction exoskeleton won’t give you ‘Iron Man-level’ superhuman strength. In essence, the vest serves to reduce musculoskeletal loads. You’ll still lift an equal amount of load as you could before. The only difference will be that the load will be lighter and easier to carry since you’ll have additional muscle support. 

The construction exoskeleton vest contains features like:

  • Lightweight frame: This makes it easy and comfortable to wear. 
  • Durable materials: The vest is built for the construction environment where they can be exposed to the harshest element and function fully without breakage.
  • Assistive: The Exo suit has an adjustable force assistance level that allows you to determine the amount of arm support you want from the suit. 
  • Natural-tracking: You can wear the suit and move naturally using your intuition, instincts, and reflexes to control it.
  • Minimal contact points: This allows workers to work unhindered with a full range of motion and great airflow for comfort.

How Does The Construction Exoskeleton Vest Work?

Exosuits work in different ways depending on how they are powered. Mechanical exoskeletons, which do not use electricity, take weight from certain parts of the body and redistribute it to other areas. For instance, it can take weight from the arms or back when doing tedious overhead work and transfer it to your core to reduce fatigue and strain on muscles and joints. Mechanical exoskeletons are more advantageous since they don’t need to be recharged to use them. So, there’s no downtime. Additionally, they offer more longevity. 

On the other hand, electric exoskeletons are more powerful and can handle more weight. They work by increasing pressure and strength in targeted areas as required. The frame responds to the wearer’s motion and provides support when needed. Due to their reliance on power, they can stop work if they run out of charge. In addition, you have to recharge them between uses. 

The construction exoskeleton vest is one of the must-have technologies for construction, logistics, and warehouse workers, and for manufacturers who are interested in increasing occupational safety. It is the best solution to reducing muscle pulls, elbow and spinal injuries, and back sprains. It represents the coming together of man and machine to make work easier and more efficient. Let’s dive into the benefits more extensively below. 

Fun Fact: The Master Mystery, released in 1919, is the first movie to feature a powered exoskeleton

5 Benefits Of Construction Exoskeletons 

You can enjoy many benefits from using industrial exoskeletons, like lifting heavy loads, performing repetitive tasks, reducing the risk of injuries, supporting joints, and increasing work efficiency. 

  1. Injury and Strain Prevention

Exoskeletons cut down on overexertion by supporting workers’ upper limbs when performing monotonous activities. They distribute the user’s weight evenly to the core and waist by reducing strain on the arms and shoulders. This leads to decreased workplace injuries like back sprains and shoulder injuries. 

  1. Withstanding Repetitive Tasks

Picture a construction worker who has to raise their arms over their heads for hours on end plastering a wall or installing drywall. That’s a daunting task, but with a construction exoskeleton, their workload is made more bearable because they have extra support for their arms. They no longer have to go home with joint and back pains, and they can work for more hours without overexerting themselves and thereby increasing their productivity. 

  1. Increased Productivity

Exoskeletons have been proven to increase workers’ endurance by reducing the amount of energy exerted on repetitive tasks. Additionally, since the frame takes on a portion of the musculoskeletal load, it reduces strain on the worker’s muscles and lowers fatigue. Coupled with less injury and strain, this becomes a great productivity enhancer for workers since they can work longer and more efficiently. 

  1. More Work Accuracy

After endless hours of overhead work, accuracy is lowered due to muscle fatigue and exhaustion. However, with an exosuit, you can practically maintain most of your attention and focus on the task at hand without the distraction of strain and fatigue. 

  1. More Opportunities For Aged Contractors

Due to the labor-intensive nature of construction work, older contractors are more likely to be limited by their physical abilities. But with a construction exoskeleton, these workers are able to handle more strenuous work effectively.


In recent years, the construction industry has experienced a lot of automation. However, not every task can be automated and replaced with a robot. There are specific, heavy and repetitive tasks that only humans can do. And the best option for attaining more efficiency and productivity in these non-autonomous tasks is to invest in well-produced exoskeletons. They are an innovative injury prevention solution and present great productivity potential in the construction industry. 

If you are considering getting a construction exoskeleton, Ekso Bionics is your best choice. We are the leading company in exoskeleton technologies and have produced some of the best products in the world for the last 17 years. We’ve worked with the United States military, DARPA, Johns Hopkins, Shirley Ryan AbilityLab, Kessler Institute, the Department for Veterans Affairs, and UCLA, among others. Our products are FDA-Approved and are based on clinical experts and feedback from industry leaders.


  2. The Effects of Upper-Body Exoskeletons on Human Metabolic Cost and Thermal Response during Work Tasks—A Systematic Review 
  4. Exoskeletons in Construction: Will they reduce or create hazards? 
  5. CPWR. The Construction Chartbook. Fifth Ed. CPWR- the Center for Construction Research and Training.  Silver Spring, MD.  April 2013. 
  7.  Exoskeletons for industrial application and their potential effects on physical work load