Category: Exoskeletons

Physical therapy can be intimidating for patients, especially if they don’t have enough information, are afraid, or don’t have any prior experience with therapy. Misinformation and fear can lead to concerns and notions, which, if not addressed, can keep patients from seeking the help they need in order to recover well. It is important for therapists to understand their patients’ concerns to address them and increase patient safety. In this article, we will address the most common concerns patients have about physical therapy and how you, as a physical therapist, can address them to ensure patient safety and comfort.

Common Concerns Patients Have About Physical Therapy

1. Some Patients Are Afraid of Pain

One of the most common misconceptions people may have about physical therapy is that it is painful. However, contrary to popular belief, physical therapy is actually designed to help relieve and manage pain, as you already know. Sometimes it takes explaining to patients the benefits of therapy in pain management and alleviation for them to understand how it works and what they should expect from it. Many people fail to realize that though therapy can be uncomfortable, it is never meant to be painful.

2. Patients May Think Physical Therapy Is Time-Consuming

Time is generally a primary concern for most people. Most patients usually have school, careers, family, and other demands on their time. Therefore, when it comes to scheduling time for physical therapy, it can seem impossible to add one more thing to their already packed schedule. On the other hand, some patients may be concerned that physical therapy will take too long. They do not want to commit weeks and months of their time to attend therapy. When you consider the busy lives we lead and how we try to fit everything into our limited schedule, you can begin to empathize with your patients and understand where they are coming from. A great solution would be creating a rehabilitation schedule that is tailored to your patient’s schedule. It can include at-home exercises and in-office rehabilitation sessions.

3. Patients May Believe Physical Therapy Is Too Expensive

Physical therapy is not familiar to most people. It’s not a program your patient may have undergone before, and people tend to be afraid of the unknown. This can be a barrier for many patients. Additionally, if your patient does not have insurance to cover their costs, paying out of pocket can be too expensive. However, you can work with patients to discuss cost-cutting strategies they can leverage to get the treatment they need. 

4. Some Patients Are Afraid That Physical Therapy Won’t Work

How do you know something is going to work, especially if you have never experienced it before? This is the same thought that may plague patients, as they may not ascertain the effectiveness of attending therapy sessions. This might be less of a concern for patients who have undergone rehabilitation before, but it can be a very real concern for patients who haven’t undergone physical therapy. To curb this, you can share success stories with your patients that qualify the importance of therapy during consultations.

When someone is suffering from mobility issues, it might be easier to convince themselves that rehabilitation won’t work rather than have hope and then get discouraged. Getting over this mental barrier may help some patients open up to physical therapy.

5. Some Patients May Be Afraid of Working With a Physical Therapist

Even though therapists normally try to be friendly and welcoming to everyone, sometimes some patients may feel uncomfortable and even afraid to do physical therapy. This may be due to personal issues like haphephobia (the fear of being touched by strangers) and uncommunicated expectations like the outcome they desire out of physiotherapy. 

6. Patients May Be Afraid of Commitment

Just like going to the gym or starting a new diet, physical therapy comes with a demand for commitment; not many patients feel they can stick it out till the end. This may keep many patients from trying because they already believe they will fail. However, working out therapy plans that work for your patients can help them conceptualize how much will be asked of them within the program. This can help them evaluate their commitment using a tangible measure compared to going at it blindly.

7. Some Patients Are Afraid of Falling

Some patients are concerned about attending therapy because of the fear of falling, clinically referred to as “ptophobia”. According to Tinetti of the Department of Medicine and Public Health at Yale University and Powell of the Department of Epidemiology and Public Health, the fear of falling (FOF) is an ongoing concern about falling that ultimately limits the performance of daily activities.[1] Reduced mobility makes patients insecure about avoiding falls, effectively keeping them out of therapy. 

8. Patients May Be Afraid of Getting Injured

Sometimes patients incur injuries during physical therapy sessions due to falls, among other reasons. This can keep prospective patients from going to therapy as they are afraid that they’ll meet the same fate. Reassuring your patients can go a long way in overcoming this fear. Addressing patient safety is a key concern in ensuring that patients are safe within rehabilitation facilities. This might go a long way in relieving patients’ fears.

In the next section, we’ll discuss patient safety and how physical therapists can ensure they observe patient safety guidelines to ensure their patients get the best care and treatment.

How to Address Patient Concerns as a Therapist

There are a few things you can do to deal with your patient’s concerns, including:

1. Understand Your Patient’s Needs

The most significant step you can take in addressing your patient’s concerns is understanding their needs. A lot of patients have different needs and concerns that can only be met if you are empathetic and understanding enough. Addressing these needs can be the start to relieving any anxiety and worry that a patient has. It can also be the foundation of trust that you need to form with a patient in order to help them through their therapy sessions. 

2. Create a Rapport With Your Patient

This will help them to open up and be more active in therapy sessions. Building a relationship with patients is the fastest way of getting them out of bed. A 2010 study studying the influence of the therapist-patient relationship on treatment outcome in physical rehabilitation said that the connection between a therapist and patient determines the treatment outcome. [1]

3. Communicate and Address Expectations Clearly

Effective communication is a primary facet of successful rehabilitation. Communication is needed to understand your patient’s needs and expected outcome. While communicating with your patients, it’s also important to tailor your communication to your patient’s literacy level when discussing ailments and treatment. Patients value clear and simple explanations about their problems.

Addressing Patient Safety

Patient safety has become an evolving area in the healthcare industry with the increase of adverse events in hospitals. Adverse events are any unintended occurrences within the healthcare system that may lead to a longer hospitalization period, disability, or death. 

According to the Canadian Patient Safety Dictionary, patient safety is “the reduction and mitigation of unsafe acts within the healthcare system, as well as through the use of best practices shown to lead to optimal patient outcomes.” [2] Physical therapists play an important role in mitigating unsafe acts within the system, directly and indirectly. Physical therapists can contribute to a culture of safety by evaluating and implementing safety measures like improving facility layouts, training staff, and being more sensitive to patients’ needs, among others, as discussed below.

Safety issues within physical therapy are not typically big and harmful events. They are normally no-harm events classified as close calls or near misses. In other words, they are events that happen to the patient but do not produce harm. For example, a patient almost falls when they are being moved from a chair. These kinds of events happen as mistakes, and it is important to identify the source of these mishaps and learn from them so as to improve patient safety. [3]

According to a 2004 study by the Canadian Medical Association Journal, some of the adverse events that normally happen in the health care system can be prevented altogether. [4] So, let’s explore some strategies you can implement to mitigate against accidents in your practice and improve patient safety.

How to Increase Patient Safety as a Therapist

You can implement several strategies to alleviate your patient’s concerns. They include: 

1. Identifying Potential Slip and Fall Risks

This is one of the easiest things you can do to increase safety in your facility. Injured patients are vulnerable to falls and slips, so it is extremely important that you ensure slippery areas are shown well. Additionally, you can station staff in risky areas to watch patients during their visit to your practice. Also, never forget to notify patients in case you identify potentially risky areas where they may fall and injure themselves. It is also important to wipe and clean any spills immediately to avoid the risk of a fall. And if your facility has bathing areas, make sure they are always kept dry to avoid injuries. Additionally, you can add non-slip rugs in the bathrooms and grab bars for support. 

2. Improving the Facility Layout

Evaluate your facility to see if patients can easily move from one area to another without straining and injuring themselves. Remember that a good number of patients attending therapy have mobility issues. A great solution to ease patient movement would be having ramps around the facility instead of stairs. You could also place all equipment and furniture out of the way of patients to avoid any falls.

3. Making Signage and Posters Visible 

Having signage and posters all over your facility is great, but they need to be visible and legible. What good is a warning poster if a patient can’t see it or be able to read it? The United States Occupational Safety and Health Administration dictates that all labels, posters, signs, and color codes must be visible enough to warn patients of possible risks. 

4. Labeling Equipment and Providing Instructions of Use

As great as equipment exercise is, it can pose a potential hazard to patients if it does not have any clear instructions for use. Instructions are normally included in any equipment you buy, but in case it is not, make your own and make sure it is visible enough to be seen by the patients using it. 

5. Training Staff 

The best way to increase patient safety and improve healthcare quality is to train staff on the latest and best ways to take care of patients. Additionally, creating a work culture that puts patient safety first can also help address patient concerns like safety. 

Conclusion

Patient concerns are ever-changing and differ from one patient to another. If left unchecked, they can keep potential patients from attending therapy and getting the help they need. When addressed, they can help patients overcome their personal barriers and attend physiotherapy sessions.

When dealing with patients, it is important to remember that you are human, and humans make mistakes. Whenever a mistake is made, the best course of action is to learn from it and make the required changes. It is also important to create a culture and environment that facilitates the identification and reporting of mistakes so that you can improve patient safety. 

References:

1. Fear of Falling | Physical Therapy | Oxford Academic https://academic.oup.com/ptj/article/82/3/264/2837020
2. The Canadian Patient Safety Dictionary https://policycommons.net/artifacts/1212508/the-canadian-patient-safety-dictionary/1765612/
3. Patient Safety and Physiotherapy: What Does it Mean for Your Clinical Practice? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909853/
4. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada https://pubmed.ncbi.nlm.nih.gov/15159366/

Postoperative therapy is a big part of the recovery process and is necessary to restore joint movement, strength, and flexibility. It might be required after surgical procedures like orthopedic, cardiac, thoracic, neurological, and abdominal surgery. Many patients may prefer skipping this step of their recovery, but this can result in improper or incomplete healing. 

Postsurgical therapy is helpful if you are experiencing stiffness, pain, muscle weakness, reduced mobility, reduced balance, and reduced coordination. It also helps with any physical and psychological effects you may have endured due to surgery. 

According to a National Institutes of Health (NIH) study, patients who stay in bed after surgery tend to lose muscle strength, heart capacity, and lung capacity due to a lack of physical activity. [1] But with the incorporation of physical therapy in recovery, you can prevent functional atrophy. This article will explore the phases of postoperative rehabilitation, types of physical therapy, and the benefits of postoperative rehabilitation. 

The 3 Phases of Postoperative Rehabilitation

There are three main phases in postsurgical rehabilitation, and they differ from patient to patient depending on the type of surgery. They are broken down into:

1. Stage 1: In this stage, you’ll be immobilized as you’ll be fresh from the surgery room. Typically, you’ll be in pain, and the surgical area will be swollen. At this point, rest is recommended for a few hours or days, depending on the type of surgery. 
2. Stage 2: In this stage, the pain and swelling will reduce. You’ll be able to move a little and will be ready to start physical therapy. The goal, at this point, is to strengthen the body, improve stability, and restore range of motion. 
3. Stage 3: In this stage, you’ll be continuing to heal and are ready to rehabilitate and learn to complete your activities of daily living. The ultimate goal of physical therapy will be achieved in this stage.

Surgery Operations That Require Postoperative Physical Therapy

These are five surgical procedures that necessitate physical therapy as part of the recovery process. They include: 

• Brain tumor surgery: A 2019 pilot study on the effectiveness of rehabilitation therapy after brain tumor surgery reported that intensive rehabilitation resulted in improved motor function, cognition function, and Activities of Daily Living (ADL). [2] In this case, physical therapists focus on range-of-motion exercises, balance, gait, and endurance training. 
• ACL and Meniscus Repair: ACL knee ligament and meniscus cartilage repair is a problem often associated with athletes. According to a 2019 study conducted by the International Journal of Sports Physical Therapy, physical therapy is vital in hastening the healing process and avoiding re-injury. Physical therapists usually focus on building quadriceps and hamstring strength in the recovery process. [3]
• Back and Spine Surgery: Physical therapy is vital, especially because of the delicate nature of spinal surgeries. Your physical therapist will show you exercises and movements for your back that don’t put pressure on your spine. Therapy strategies normally include stretches and exercises that get the blood flowing. In the case of more invasive surgeries, for example, spinal fusion, your therapist can monitor your back health and update your doctor on the healing progress.
• Heart Attack/Bypass Surgery: According to a 2018 study by the Journal of Physical Therapy Science, preoperative physical therapy can help prevent cardiopulmonary complications by offering patients a safe space to move. Low-impact exercises tend to improve health and reduce your stay in the hospital. Coupled with postoperative therapy, you can recover faster while avoiding all postsurgical complications. [4] 
• Achilles Tendon Release (Tenotomy): This is a type of surgery that is done to fix a damaged or contracted Achilles tendon. This procedure can be performed to relieve shortened and stiff muscles to allow for better range of movement. This is a common problem for patients with spinal cord injuries because, after a spinal cord injury, the normal flow of nerve signals is disrupted and feet tend to relax into a toe-pointed position. This could limit a person’s ability to stand if not corrected. 

Major Types of Physical Therapy For Postoperative Patients

Physical therapy strategies are not one-size-fits-all. The type of therapy recommended always depends on your physical condition and biomechanical needs. In this section, we will explore rehabilitation methods that are applicable to patients who have undergone any kind of surgery. 

1. Stretching

After surgery, the soft tissue normally contracts, and scar tissue forms. This can decrease flexibility and make it difficult for you to move. However, regular stretching can help prevent immobility caused by scar tissue. It also helps increase joint flexibility and a full range of motion in case of joint surgeries. Overall, stretching makes life much easier and allows you to do simple tasks like reaching over your head, walking, and even climbing stairs. 

Stretching has also been shown to help improve balance and reduce pain by relaxing tense or spasming muscles. Lower back, abdominal, hip, and leg muscle stretches are recommended if you’ve undergone back surgeries.

Common hamstring exercises targeting the outer hip and lower back include Knee to Chest Stretch, Figure 4 Stretch, Pigeon Stretch, and Doorway Hamstring Stretch. These stretches are particularly great for tight and restricted muscles. The Pigeon Stretch and Doorway Hamstring Stretch are more advanced and should only be performed in a pain-free range. Other types of stretches used in postoperative therapy include:

2. Range of Motion Therapy

Range of motion (ROM) is concerned with how far you can move an affected joint or limb in all directions and positions naturally without strain and pain. There isn’t one standard definition of ROM. According to Dr. Aldalbert Kapandji, who specializes in physical therapy, range of motion is “the extent of osteokinematic motion available for movement activities, functional or otherwise, with or without assistance.” [5] 

Range of motion exercises increase movement, reduce pain, and improve joint integrity and function. Range of motion exercise and stretching are generally performed in the first phase of rehabilitation to help regain joint functionality before moving to more advanced practices.

Range of motion therapy normally includes: 

• Passive routines where the therapist guides your movements. 
• Interactive routines where both you and the therapist do the work.
• Active routines where you do the exercises on your own. 

Range of motion exercises involving circling joints and knee extensions are beneficial in different situations, including:

• Soft tissue and joint recovery
• Joint and soft tissue mobility
• Neuromuscular reeducation
• Synovial movement enhancement 

3. Strengthening

Strengthening exercises are a crucial part of physical therapy and help improve muscle function around the surgical area. Strengthening exercises are customarily performed alongside or after the range of motion exercises because increased joint movement without an equal increase in strength might cause injury.

Strengthening exercises are also vital in improving your core strength. The core is a major focus area because it is the source of stability. Rebuilding core strength improves stability and mobility and helps prevent additional injuries. It allows you to increase the load you can handle without overexerting and injuring yourself. In addition, strengthening can also be used for the back and pelvis areas. Strengthening exercises typically include leg raises, hamstring and quadriceps contractions, and squats using a chair.

Strengthening exercises can also include bridge exercises and ball bridge exercises. These exercises are great for strengthening the hamstring, lumbar extensor, pelvic, back, and buttocks. These exercises should be done in a pain-free range; once you’ve mastered them, you can move on to more advanced strengthening exercises. 

4. Ultrasound and Electrical Therapy

Ultrasound and electrical therapy help improve blood flow and retrain nerves. Ultrasound therapy involves the use of high-frequency sound waves on deep tissue. The high-frequency sound waves used to stimulate deep tissue are so low that even the human ear cannot pick them up. This type of therapy utilizes a probe for administration and is known to reduce pain, accelerate healing, and reduce inflammation in the soft tissues. A 2014 study conducted by the Journal of Physical Therapy Science reported that therapeutic ultrasound increases range of motion and pain threshold for at least 20 minutes. [6]

Electrical therapy involves the use of low electrical current on the deep tissues. Electrical stimulation works by sending small electrical currents to the targeted area and the nerves surrounding it. It is extremely helpful in increasing blood flow, pain management, and improving muscle flexibility. A 2021 study conducted by Frontiers in Medicine reported, “As a supplementary treatment after total knee arthroplasty, postoperative neuromuscular electrical stimulation could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function.” [7]

5. Gait Training

Walking is a great physiotherapy technique that’s primarily used for neurosurgery patients. It normally involves rewiring and training the brain to control walking muscles. This is achieved because of the brain’s neuroplasticity – the ability of the brain to form and reorganize synaptic connections. When walking is practiced regularly after surgery, it allows the brain to strengthen and create neural pathways that support movements involved in walking. Some high repetition walking exercises include leg and balance exercises.

Benefits of Postoperative Therapy

General Surgery 

A postoperative therapy program after general surgery is a crucial part of recovery and offers a host of benefits like: 

1. Proper Healing and Faster Recovery Time

Many complications can arise after surgery, including infection and muscle atrophy, which might lead to poor healing. That’s why postoperative therapy is important. Postoperative therapy can help wounds heal properly by minimizing scar tissue, retraining muscles, and recovering joint function. It also allows you to enjoy a faster recovery time. According to a 2017 study conducted by Acta Medica, beginning physical therapy following a joint replacement surgery can reduce your hospital stay and help you recover faster. [8]

2. Patient Participation

Patients who actively participate in their own recovery process have been shown to have better results and recovery experiences than those who don’t in a 2013 review conducted by researchers from the Health Policy Research Group at the University of Oregon. [9]

3. Improves Mobility

Joint replacement surgeries normally result in reduced mobility, making activities that may seem ordinary, like walking, difficult. This happens because of the body’s natural response, which is to protect the area of surgery by swelling, reducing the range of motion, and tightening the muscles. This makes physical therapy extremely important, especially after knee and hip replacement surgeries, as it may help you recover your mobility through targeted postoperative therapy practices. 

4. Eases Pain and Swelling

Swelling and pain after surgery normally vary from one person to another. The pain usually arises when chemicals that stimulate nerve endings are released, and the excess inflammation compresses the nerves. Exercises are a great tool for reducing swelling, which results in improved mobility, faster healing, and reduced pain. Postoperative physical therapy administration can also help in preventing chronic pain.

According to a 2013 review conducted by London-based medical researchers, postoperative therapy is quite effective in improving short-term lower back pain and long-term lower back and leg pain if you’ve undergone lumbar spinal stenosis surgery. [10]

5. Reduces Scar Tissue Formation

During the healing process, scar tissue forms, and tissues contract. This normally leads to scarring and reduced mobility. However, mobilization techniques can help prevent this using ultrasound therapy, which effectively increases flexibility and softens the scar tissue. According to a 2016 study conducted by researchers for the Internal Medicine Review journal of Washington D.C., low-intensity therapeutic ultrasound can help treat soft tissue injuries and improve musculoskeletal and post-operative recovery outcomes. [11]

6. Reduces the Development of Secondary Issues

Physical therapy can help reduce surgical complications like blood clots, and infection, among others. Specific exercises and movements may help in reducing the risk of contractures and other complications.

7. Improves Flexibility

Staying in bed after surgery is detrimental for you, and it may lead to weak muscles, which will make you susceptible to injury. When your joints become stiff, activities like walking, climbing stairs, and reaching overhead can be compromised. However, stretching exercises can help you keep your joints flexible and muscles limber. 

Neurosurgery

Neurosurgery is involved with the treatment of conditions affecting the nervous system, including the spinal cord, brain, and peripheral nervous system. This makes postoperative rehabilitation very important as part of helping a patient regain their pre-surgery functionalities. Benefits attributed to physical therapy include:

• Increased Range of Movement – Patients are able to increase their limb and joint movement in any direction without any pain.
• Improved Gait – Physical therapy can help you improve your balance, coordination, and walking movement control.
• Increased Muscle Strength – Physical therapy is great for training leg and back muscles to support the weight of the body. 
• Reduced Spasticity and Contractures (Shortened Muscles) – Surgery may lead to muscle tightness, otherwise referred to as spasticity, which can limit movement and cause pain. But physical therapy can help you avoid these complications.

Conclusion

Postoperative therapy is vital when you are recovering from surgery, and its efficacy has been shown in different studies. It will help you heal faster, regain mobility, reduce pain, and prevent postoperative complications. In case you’ve undergone surgery, physical therapy will offer you the recovery support you need on your healing journey.

References:

1. Assessing the effectiveness of routine use of post-operative in-patient physical therapy services https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506300/
2. Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509576/
3. Restoring knee extensor strength after anterior cruciate ligament reconstruction: a clinical commentary https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350662/
4. Prevention of postoperative pulmonary complications through preoperative physiotherapy interventions in patients undergoing coronary artery bypass graft: literature review  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110234/
5. The clinical evaluation of the upper limb joints’ function: back to Hippocrates https://www.sciencedirect.com/science/article/abs/pii/S0749071203000295?via%3Dihub
6. Effects of Therapeutic Ultrasound on Range of Motion and Stretch Pain  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047237/
7. Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677678/
8. Early rehabilitation after elective total knee arthroplasty  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357664/
9. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs https://www.ncbi.nlm.nih.gov/pubmed/23381511
10. Rehabilitation following surgery for lumbar spinal stenosis – McGregor, AH – 2013 | Cochrane Library https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009644.pub2/abstract
11. Low-Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128661/

According to the World Health Organization (WHO), between 250,000 and 500,000 people suffer from spinal cord injuries (SCIs) every year due to blunt force trauma, road crashes, falls, and other mechanisms of injury. [1] A few years ago, this would have meant the end of autonomy and mobility for many people, but thanks to advances in technology, there are more rehabilitation therapies available, including exoskeletons. The FDA designates medical exoskeletons as a class II (intermediate risk) medical device, and they are cleared for use with patients who have an SCI. [2]

Exoskeletons give people with spinal cord injuries a chance to ambulate, exercise, and engage in mobility and autonomous activities. In this article, you’ll learn what exoskeletons are, how they operate, and how they can be beneficial in physical therapy for patients with spinal cord injuries.

What is a Spinal Cord Injury (SCI)?

According to the National Institute of Neurological Disorders and Stroke (NINDS), a spinal cord injury is “damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body.” [3] SCIs could be a direct result of damage to the spinal cord itself, such as from a gun shot wound, but could also result from damage to surrounding tissues and bones that then compress the spinal cord. These injuries can permanently or temporarily affect mobility, sensation, and other body processes. Depending on the extent and location of the damage to the spinal cord, patients may experience some form of paralysis and/or sensory deficits that could be improved through rehabilitation, potentially leading to full recovery.

The most common causes of SCI are grouped into traumatic and non-traumatic causes. Traumatic SCI causes may include car accidents, falls, and sports-related accidents. Non-traumatic causes include tumors, neurodegenerative diseases, infections, and genetic causes. 

Rehabilitation Methods Available for Patients with Spinal Cord Injury

Rehabilitation therapies for patients with a spinal cord injury depend on the extent of damage and the type of injury. Patients usually start in the intensive care unit, followed by acute care, inpatient, and outpatient rehabilitation. Some hospitals even have a spinal cord injury department that specializes in this type of rehabilitation. This can last anywhere from three to twelve months or more, depending on the severity of the injury. Popular rehabilitative techniques include: 

1. Range of Movement, Strength, and Stretching Exercises

Spinal cord injuries limit the range of movement by causing joint immobility and flexibility issues. However, this can be remedied using stretching and strength exercises. According to a 2020 study, range of movement exercises help “prevent contractures, protect tenodesis effect, strengthen paralyzed muscles, promote nerve and cerebral remodeling, and improve spinal microenvironment and functional prognosis.” [3]

2. Functional Electrical Stimulation

Functional electrical stimulation works by artificially stimulating the sensory-motor systems using electrical pulses. It activates neural pathways, which stimulate the muscles and cause movement. This therapy is used alongside other rehabilitation methods in order to restore mobility. According to a study, this procedure also “provides cardiorespiratory fitness; improves posture and trunk stability; prevents contractures, pressure ulcers, and orthostatic hypotension; promotes nerve restoration; and prevents peripheral nerve deterioration.” [4]

3. Epidural Electrical Stimulation (EES) of the Spinal Cord

In this procedure, a device is implanted over the spinal cord’s dura mater through a laminectomy. It then produces a rhythmic electric pulse to the posterior nerve roots, which activate the central circuits which are responsible for regulating pain, movement, and the cardiorespiratory system. EES is beneficial for reducing fatigue, improving cardiovascular fitness, increasing body mass, and improving urination in patients. [4] However, this is not a simple procedure, as patients must undergo surgery for the device to be implanted and is not yet widely available. 

4. Transcutaneous Electrical Nerve Stimulation (TENS)

TENS utilizes a high and low electrical stimulation to the nerve to manage pain. It may also help with proprioception, balance, and spasticity. This method is very affordable, and patients can do it by themselves without much assistance.  

5. Occupational Therapy

Occupational therapy focuses on improving the physical, sensory, and cognitive functions of the patients. It helps patients suffering from SCI regain their autonomy and independence. It focuses on the execution of daily activities like grooming, bathing, cooking, and dressing, among others. Occupation is the gateway that helps patients attain inclusion and total adaptation to their environment.

6. Robotic Exoskeletons

Wearable robotics, also known as robotic exoskeletons or exosuits, are a recent development in the healthcare industry that present unlimited potential for patients with spinal cord injuries and are used in conjunction with physical therapists. Robotic exoskeletons are used in rehabilitation to help in mobility recovery through repeated movements that lead to increased neural plasticity. [5] Exosuits offer benefits like improved gait, better life quality, improved moods, and better bladder control, among others, as discussed below.

According to Dr. Chester Ho, Associate Professor at the University of Calgary’s Department of Clinical Neurosciences and member of the Hotchkiss Brain Institute, introducing robotic exosuits early in a patient’s rehabilitation process offers better chances of recovery. He says, “The first nine months after a spinal cord injury are pivotal to recovery, so we want to attempt to introduce rehabilitation and mobilization early on and see if it makes a difference.” [6]

What Is An Exoskeleton?

Exoskeletons, first developed in 1890, are wearable electromechanical devices that support joint movement while enhancing the wearer’s strength and ambulatory capabilities. An exoskeleton frame is made to surround the waist and other joints like the shoulders and knees. Exoskeletons can be classified into two types: active, powered by an external power source; or passive, powered by mechanical springs and counterbalance forces. 

Exoskeletons are used in physical rehabilitation clinics to promote a patient’s mobility and increase their muscle strength. They do this by allowing for repeated movements that increase neural plasticity and help develop mobility. [4] The use of exoskeletons in physical therapy is reported to increase “quality of life, body composition, bone density, neuropathic pain, spasticity, gait speed, number of steps, and distance before and after 90 days of training.” [4]

How Are Exoskeletons Controlled?

Exoskeleton control is vital in a physical therapy environment. Exoskeletons offer multiple control modes, and operators can choose the amount of resistance that is applied at the joints. Exoskeletons can be controlled by the patient or physical therapist depending on the degree of patient recovery. Control methods include: [7]

• Sensors: Sensor-controlled exosuits have numerous sensors fitted into the build that capture nerve signals and control torque, pressure, tilt, and rotation. 
• Buttons/control panels: Some exosuits contain pre-programmed modes, which are normally controlled by the user or by the physical therapist. Most control panels are located on the walking aids.
• Joystick: This is commonly found in active exosuits that provide all the energy required by the wearer.
• Mind-Controlled: These use an electrode skull cap as the main method of control.

No-control: Most passive exosuits do not have control buttons and respond to the mechanical movements of the wearer.

Exoskeleton control is vital in a physical therapy environment. Exoskeletons offer multiple control modes, and operators can choose the amount of resistance that is applied at the joints. Exoskeletons can be controlled by the patient or physical therapist depending on the degree of patient recovery. Control methods include: [7]

• Sensors: Sensor-controlled exosuits have numerous sensors fitted into the build that capture nerve signals and control torque, pressure, tilt, and rotation. 
• Buttons/control panels: Some exosuits contain pre-programmed modes, which are normally controlled by the user or by the physical therapist. Most control panels are located on the walking aids.
• Joystick: This is commonly found in active exosuits that provide all the energy required by the wearer.
• Mind-Controlled: These use an electrode skull cap as the main method of control.

No-control: Most passive exosuits do not have control buttons and respond to the mechanical movements of the wearer.

Types of Medical Exoskeletons

All exoskeletons are not built equally. They have different features and capabilities. In addition, the use of medical exoskeletons may differ between individuals based on the extent of injury and their recovery capacity. Exoskeletons are normally divided into:

• Upper Body Exoskeletons

Upper body exoskeletons are built to support the upper extremities, including the arms and torso. They are specifically designed to help patients with upper-body motor rehabilitation by positioning the shoulder, arm, and elbow through specific motions and orientations. They are extremely important to therapists because they can be used for intense motor exercises and task-specific movements.

• Lower Body Exoskeletons

Rehabilitative lower body exoskeletons are made for patients with lower limb motor dysfunctions to enable the recovery of lower extremity mobility. They normally use impedance control to generate resistance forces which are essential for rehabilitation training. Lower body exoskeletons have the ability to control joint movement in the hip, knee, and ankle.

Benefits of Using Exoskeletons After Spinal Cord Injuries

Exoskeletons are advantageous for patients and therapists alike. They have the ability to reduce the burden on therapists and help with quantitative data collection and patient evaluation.

1. Gait Training:

Gait training consists of walking practice with the aim of helping the patient regain their normal walking gait. Using exoskeletons has the potential to make gait training easier and more convenient for therapists, given the numerous support features they offer. For instance, free-standing exoskeletons help patients to exercise in upright positions, which would be almost impossible and cumbersome without the use of exoskeletons. [8]

A 2008 gait training study carried out on two stroke survivors reports that “by the end of the training the gait pattern of the patients improved and became closer to a healthy subject’s gait pattern.” Improvement in this study was defined as “the increase in the size of the patients’ gait pattern, increased knee and ankle joint excursions and increase in their walking speeds on the treadmill.” [9] Exoskeletons also have unique features that help with rehabilitation. For example, the EksoNR has sensors that are made to monitor your patient’s leg movements and regulate their gait patterns. [10] 

2. Bladder and Bowel Function:

The use of exoskeletons may improve your patient’s bladder and bowel function. This is according to feedback that was received by researchers at the Spinal Cord Injury Model System Centers (SCIMS) from focus groups held with 30 therapists. They record that, “patients who gained the ability to stand and walk with an exoskeleton often developed better endurance, improved their bowel and bladder control, and were less likely to develop urinary tract infections.” [11]

Scientists believe that engaging patients in physical activities and maintaining upright postures may play a role in improving bowel motility. A 2019 study tested bowel management after exoskeleton training and reported an improvement of up to 80%. [12]

3. Improved Muscle Strength and Spasticity:

Incorporating exoskeletons in your physiotherapy treatment may help patients improve their muscle strength. A 2021 study examining the effects of exoskeletons in physiotherapy observed that the use of exoskeletons improved grip strength, quadriceps strength, and lower limb motor function. [8] This was also observed in a 2019 study that reported exoskeletons improved muscle strength after a Manual Muscle Strength Test, “total score from both sides were: P3 UEMS increased from 30 to 37, and LEMS from 23 to 25; P11 UEMS increased from 33 to 37, and LEMS from 27 to 30, where the maximum score for UEMS and LEMS is 50.” [13]

Another study conducted on patients who had a stroke concluded that the use of exoskeletons in therapy improved the tibialis anterior muscle strength and lower limb motor function of the patients. [14]

4. Improved Patient Moods:

Though not a significant benefit, the use of exoskeletons in therapy can help improve your patient’s moods. A 2021 study examining the effects of exoskeletons on patients with spinal cord injuries shows improved moods in one of the patients during the rehabilitation phase. It also reports a decrease in fatigue and an improved quality of life. [8] Since robotic exoskeletons are a “new” technology in rehabilitation, they can be exciting for patients and may motivate them to exercise more. Some therapists also report that exoskeletons offer extra psychological benefits to patients. For instance, patients reported psychological effects of having eye-to-eye conversations with others and also increased engagement in daily activities. [11]

5. Patient Independence:

Exoskeletons can help patients gain some independence in their day-to-day activities like moving and walking around. Before the invention of medical exoskeletons, patients had to rely on their therapists to move around and exercise. However, that is no longer the case. They can now exercise and ambulate on their own, which gives them a sense of independence. Physical therapist Kyle McIntosh says, “The exoskeleton lets patients take actual steps, which is not only more realistic but much less cumbersome,” McIntosh also says, “Every step is different with this device, so patients learn from their mistakes in real time. Patients really like to use the device; it gives them hope.” [6]

Conclusion

Rehabilitative technology has come a long way, from crutches to walkers to wheelchairs and now, robotic exoskeletons. Robotic-assisted rehabilitation holds a lot of promise for both patients and physical therapists alike. Several studies have shown the potential benefits of exercising in a free-standing exoskeleton for patients with spinal cord injuries. If you are a physical therapist, this is the next medical technology shift that will help you offer next-level therapy solutions for your patients.

Ekso Bionics has been at the forefront of creating the best quality medical exoskeletons for more than a decade now. Our EksoNR was one of the first FDA-approved medical exoskeletons for rehabilitation, and it continues to be the exoskeleton of choice for many mobility rehabilitation clinics. Please review our indications for use to determine eligibility. [15]

References: 

1. Spinal cord injury https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury#:~:text=Key%20facts,traffic%20crashes%2C%20falls%20or%20violence. }
2. Exoskeletal Assisted Rehabilitation After Spinal Cord Injury https://www.sciencedirect.com/topics/nursing-and-health-professions/exoskeleton-rehabilitation
3. Spinal Cord Injury https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury
4. Rehabilitation Therapies in Spinal Cord Injury Patients https://www.intechopen.com/chapters/72439
5. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review https://pubmed.ncbi.nlm.nih.gov/29987763/ 
6. Spinal cord injury patients may benefit from using exoskeleton earlier in treatment https://ucalgary.ca/news/spinal-cord-injury-patients-may-benefit-using-exoskeleton-earlier-treatment
7. Types And Classifications of Exoskeletons https://exoskeletonreport.com/2015/08/types-and-classifications-of-exoskeletons/
8. Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-021-00967-4
9. Robot Assisted Gait Training With Active Leg Exoskeleton (ALEX) https://ieeexplore.ieee.org/document/4663875
10. https://eksobionics.com/eksonr/ 
11. Robotic Exoskeletons May Provide Health Benefits for People with Spinal Cord Injuriesnhttps://naric.com/?q=en/content/robotic-exoskeletons-may-provide-health-benefits-people-spinal-cord-injuries
12. Changes in Bowel Function Following Exoskeletal-Assisted Walking in Persons with Spinal Cord Injury: An Observational Pilot Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145720/
13. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868817/
14. Impacts of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients https://www.researchgate.net/publication/344023059_Impacts_of_a_lower_limb_exoskeleton_robot_on_the_muscle_strength_of_tibialis_anterior_muscle_in_stroke_patients/fulltext/5f519787a6fdcc9879c9cc2f/Impacts-of-a-lower-limb-exoskeleton-robot-on-the-muscle-strength-of-tibialis-anterior-muscle-in-stroke-patients.pdf 

Work injuries are any injuries that arise during the course of employment. They may be categorized as traumatic, chronic exposure, psychological or emotional injuries. Among industrial workers, traumatic injuries are the highest due to the physically demanding nature of their jobs. This leads to Workplace Musculoskeletal Disorders (WMSDs) such as strains, sprains, bone fractures, back pain, carpal tunnel syndrome, tendonitis, osteoarthritis, hernia, among others.

Construction and industrial workers are at a higher risk of WMSDs, given the physical demands of their jobs. WMSDs are any conditions that involve soft tissues like muscles, nerves, cartilage, etc. According to the Centers for Disease Control and Prevention (CDC), construction workers have increased workplace musculoskeletal injuries associated with exposure to vibrations, awkward postures, and repetitive tasks during work. [1]

However, all is not lost. Ergonomic innovations and technologies like exoskeletons may hold the answer to reducing workplace-related injuries. They are task-specific robotic tools that help with reducing the load of repetitive work, reducing discomfort in awkward postures, and bearing extra weight on the body. Exoskeletons have wide applications and may be useful in a variety of industries such as, automotive, manufacturing, logistics, construction, and shipping industries.

Common Causes of Workplace Musculoskeletal Injuries

Construction environments are typically overflowing with activity and demand high amounts of physical exertion. This typically leads to overexertion as a result of lifting, carrying, pulling, holding, and pushing tasks – all inevitably leading to injury. In construction, workplace musculoskeletal injuries are commonly caused by repetitive work, strenuous work positions, continuous exertion and vibration. 

1. Repetitive Tasks

Repetition plays a big role in workplace injuries. Did you know workers lift their arms up to 4,600 times a day on average — consider how much toll this takes on their upper extremities. Repetitive tasks are very hazardous because they lead to repeated strain in the same muscle groups and joints. This can lead to injury and disability, which eventually impacts productivity and work efficiency. If the cycle time of your job is 30 seconds or less, it is classified as a repetitive job and may expose you to a higher risk of work injury.

2. Awkward Work Positions

Awkward positions include any position that differs from the natural body positions we should inhabit while working. Even maintaining the same position in normal postures for long periods of time usually leads to fatigue. Now consider unnatural work positions; they lead to muscle inefficiency and exertion, which inadvertently leads to musculoskeletal injuries. Examples of common awkward postures include prolonged standing, which may cause fatigue and lower back pain, bending forward, which can cause lower back injuries, and reaching overhead which may cause damage to your shoulders and arms. Sometimes, maintaining fixed positions may also lead to stiffness and injury.

3. Continuous Exertion

The human body is not designed to take on continuous force and exertion. It needs recovery time in order to regain strength and vitality. Unfortunately, long work hours subject our bodies to constant exertion with limited recovery time. This leads to accumulated fatigue in certain body parts like the lower back, which makes them prone to injury. Continuous exertion exposes the same muscle groups and body parts to wear and tear, which may lead to injury if not attended to.

According to the Center for Construction Research and Training, overexertion is the leading cause of WMSDs, causing up to 67% of musculoskeletal disorders among construction workers in 2015. [2] Apart from causing WMSDs, overexertion  also results in lost productivity, disability, and costly medical expenses. The effects of overexertion are also experienced on a more significant economic scale. According to the CDC, “the economic burden of construction industry worker’s compensation costs brought on by WMSDs in the United States has been estimated to be more than $2 billion annually (Liberty Mutual 2021).” [1] 

4. Vibration

Vibration may affect the whole body or a specific body part. It usually affects workers who operate power tools, machines, and even trucks. Vibration can affect the nerves, muscles, tendons, and joints, and it usually results in fatigue, pain, loss of touch, and numbness. Continuous exposure to vibration is very detrimental to workers.

What Are Exoskeletons?

Exoskeletons, also known as exosuits, were first developed in 1890. They are wearable frames that provide support and enhance the wearer’s capabilities. Exoskeletons amplify the strength of the wearer and augment their physical performance. While they do not give superhuman strength to the individual, exoskeletons are instrumental in increasing productivity, supporting heavy lifting, and reducing physical workload. This has an overall positive effect on reducing musculoskeletal injuries.

Exoskeletons can be classified into two: passive or active. Passive exoskeletons are mechanical, use springs, and counterbalance forces to operate, whereas active exoskeletons use powered mechanisms like hydraulics and electric motors. Despite their differences, passive and active exoskeletons are equally used in providing support to the waist, shoulder, and thigh. However, research shows passive exoskeletons are preferred in industrial workplaces. [3]

Types of Industrial Exoskeletons

There are two main types of industrial exoskeletons: upper-body exoskeletons and lower-limb exoskeletons. Although both reduce the risk of WMSDs, they operate differently and provide support to different parts of the body.

1. Upper-Body Exoskeletons

Upper-body exoskeletons are designed similarly to a backpack. They support the upper extremities and play a significant role in reducing shoulder injuries, particularly among workers who engage in repetitive overhead work. The exoskeleton engages every time you raise your arms or lift something and creates a counterbalancing force that reduces the total load and provides support. This makes completing the task at hand easier and safer.

Upper-body exoskeleton technology is continuously improving and evolving. For instance, Ekso Bionics changed the Ekso EVO from a “backpack” design to a “strap” design that makes the exoskeleton extremely lightweight and comfortable to wear. [4] EVO provides 5 – 15 lb. (2.2 – 6.8 kg) of list assistance per arm to give your natural strength a boost throughout your work day. This is not intended to give you super strength but instead give you super endurance and reduce fatigue so that you have more energy and less soreness at the end of your shift. Whatever payload you normally lift (a 4 lb. torque wrench, a 10 lb. component, or even just the weight of your arm) will feel lighter with the boost you get from your EVO.

2. Lower-Limb Exoskeletons

Lower-limb exoskeletons are generally designed to support the lower body and augment strength when moving or performing heavy tasks. They are made to support joints like your hips, knees, and ankles. Lower-limb exosuits offer support any time you bend or lift a heavy load by passing on the weight to your legs, thus relieving the lower back from heavy weight. [5] Lower-body exoskeletons normally follow the wearer’s motions and respond to the different actions they take.

Benefits of Using Exoskeletons at Work

Exoskeletons present many benefits to construction workers. They provide ergonomic assistance when performing repetitive tasks, enhance worker safety when working in hazardous environments and even reduce fatigue. They remain to be an unrivaled innovation for reducing Workplace Musculoskeletal Disorders and present a practical solution to workplace safety.

1. Improved Comfort At Work

Exoskeletons are lightweight, easy to use, and are  made with comfortable materials that help reduce discomfort when wearing them. For instance, Ekso EVO is made with a compact design that is designed to minimize the exoskeleton’s weight for easy wearability. Ekso EVO also has minimal touch-points, which help you keep cool while working, improving your overall comfort. 

2. Reduced Fatigue

Exoskeletons reduce fatigue by bearing the weight of heavy loads. They do this by distributing the wearer’s weight evenly to the core and waist, thus reducing repetitive force on specific body parts. Some exoskeletons also use counterbalance forces to provide support to the wearer. According to the CDC, “Back assist exoskeletons were found to reduce back muscle activity by 10-44% during handling tasks, and hip extensor muscle activity was reduced by 24% in laboratory studies.” [1] In a 2015 study, researchers reported up to 80% muscle activity reductions due to the use of active exoskeletons. [6]

3. Increased Productivity

Exoskeletons are great at boosting productivity and efficiency. They help workers lift heavier loads for more extended periods of time, effectively increasing the amount of work one can do per day without compromising physical health. Exoskeletons also improve speed and accuracy, which results in a more efficient workflow. Apart from productivity, exoskeletons help workers end shifts with more energy and less soreness, which goes a long way in improving morale. Increased productivity also positively affects a company’s bottom line due to improved output and less sick days.

4. Reduced Injury and Sick Days

According to the U.S. Bureau of Labor Statistics, workplace injuries result in an average of 34 days of sick leave. [7] According to the 2021 AmTrust Contractor Risk Report, 34% of workplace injury claims come from plumbers and 27% from electricians who have repetitive overhead tasks, which lead to strain and musculoskeletal injuries. [8] Exoskeletons can help reduce workplace injuries which effectively reduces the number of sick days workers have to take. 

Exoskeletons reduce the load that workers bear and offer support to the shoulder and arms in case of overhead tasks. This helps minimize repetitive wear and tear on body parts, reducing the number of work-related injuries. Ford Motor Company has been at the forefront of acquiring exoskeletons for their workforce, and since 2011, they have recorded an 83% reduction in workplace injuries in departments that use exoskeletons. [9] The CDC also believes that exoskeletons are the best alternative to reducing musculoskeletal injuries and associated costs in different industries. [1]

5. Improved Work Quality

Exoskeletons may help improve the quality of work since workers are less fatigued, which contributes to alertness and accuracy. This results in a higher level of work output within shorter periods of time, boosting productivity. [10]

Conclusion

Occupational exoskeleton technology is undeniably the next-best solution to reducing workplace injuries, especially in industries that require heavy lifting and expose workers to repetitive tasks and awkward working positions. Exoskeletons are beneficial in reducing strain, fatigue, injury, and improving overall productivity. Just to show how critical exoskeletons are for work, in 2019, Toyota made upper-body exoskeletons a mandatory part of Personal Protective Equipment (PPE) for workers who engage in overhead work.

Ekso Bionics has been at the forefront of producing the best-in-class wearable technology for years, and all our exoskeletons are made with insight from industry experts and stakeholders. Our Ekso EVO exoskeleton vest is the product of choice among workers who care about their health and comfort while performing their daily activities. Ekso EVO remains to be the go-to exosuit for our partners, Boeing and Ford. [4]

References:

1. Exoskeletons: Potential for Preventing Work-related Musculoskeletal Injuries and Disorders in Construction Workplaces https://blogs.cdc.gov/niosh-science-blog/2022/02/03/exoskeletons-construction/
2. Chart Book (6th edition): Fatal and Nonfatal Injuries – Musculoskeletal Disorders in Construction and Other Industries https://www.cpwr.com/research/data-center/the-construction-chart-book/chart-book-6th-edition-fatal-and-nonfatal-injuries-musculoskeletal-disorders-in-construction-and-other-industries/
3. The Effects of Upper-Body Exoskeletons on Human Metabolic Cost and Thermal Response during Work Tasks—A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600262/ 
4. https://eksobionics.com/ekso-evo/ 
5. Exoskeletons are reducing ergonomic injuries https://www.thesafetymag.com/ca/topics/technology/exoskeletons-are-reducing-ergonomic-injuries/184498#:~:text=%E2%80%9CWe%20know%20that%20in%20a,compressive%20forces%20in%20the%20spine
6. Exoskeletons for industrial application and their potential effects on physical work load https://pubmed.ncbi.nlm.nih.gov/26444053/ 
7. Occupational Injury and Illness Classification Manual https://www.bls.gov/iif/oshoiics.htm
8. AmTrust 2021Contractor Risk Report  https://amtrustfinancial.com/contractor-report
9. How Exoskeletons Impact The Workplace https://eksobionics.com/how-exoskeletons-impact-the-workplace/ 
10. https://eksobionics.com/manufacturing/

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.”

Conclusion

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.

References:

(1) https://www.biausa.org/public-affairs/public-awareness/brain-injury-awareness 

(2) https://www.headway.org.uk/about-brain-injury/further-information/statistics/ 

(3) https://www.biausa.org/brain-injury/about-brain-injury/basics/overview 

(4) https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/ 

(5) https://eksobionics.com/indications-for-use/ 

(6) https://eksobionics.com/acquired-brain-injury/ 

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

https://pubmed.ncbi.nlm.nih.gov/15063052/

(8) https://eksobionics.com/eksonr/ 

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

https://www.hindawi.com/journals/abb/2020/8845772/

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

https://www.e3s-conferences.org/articles/e3sconf/abs/2020/45/e3sconf_iceeb2020_03036/e3sconf_iceeb2020_03036.html

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

https://journals.sagepub.com/doi/10.1177/0269215520927454

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562032/

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

https://www.hindawi.com/journals/np/2020/8856621/

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. 

2. 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. 

3. 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. 

4. 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. 

5. 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.

Conclusion

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.

References:

1. https://eksobionics.com/eksoworks/
2. The Effects of Upper-Body Exoskeletons on Human Metabolic Cost and Thermal Response during Work Tasks—A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600262/ 
3. APPARATUS FOR FACILITATING WALKING, RUNNING, AND JUMPING. No. 420,179 https://patents.google.com/patent/US420179A/en 
4. Exoskeletons in Construction: Will they reduce or create hazards? https://blogs.cdc.gov/niosh-science-blog/2017/06/15/exoskeletons-in-construction/ 
5. CPWR. The Construction Chartbook. Fifth Ed. CPWR- the Center for Construction Research and Training.  Silver Spring, MD.  April 2013. http://www.cpwr.com/publications/construction-chart-book 
6. https://eksobionics.com/construction/
7.  Exoskeletons for industrial application and their potential effects on physical work load https://pubmed.ncbi.nlm.nih.gov/26444053/ 

Every year, 55.9 million people suffer from an acquired brain injury (ABI), which is any injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. 15 million suffer from strokes, or cerebral vascular accident (CVA)—the fifth leading cause of death in the United States and a major cause of long-term disability.  A stroke results when part of their brain is deprived of oxygen caused by a blood clot blocking blood flow or by a rupture in the artery feeding blood to a part of the brain. Up to 500,000 people suffer from spinal cord injury (SCI), classified by decrease or complete loss of sensation and/or movement below the level of injury.

As a result, those with an ABI, CVA, or SCI may be left with limited mobility or some form of paralysis. This can be a devastating diagnosis that is completely life-changing for patients and their families.

Human robotic exoskeletons offer a new, promising approach to restoring mobility after such injuries. Health experiences including regained mobility, as well as improved oxygen intake, bowel and bladder function, joint maintenance, circulation, and easement of pain have been shown in patients using robotic exoskeletons. With the use of human robotic exoskeletons, patients who are working with physical therapists can regain basic movements or even develop the ability to walk again independently.

What are Exoskeletons?

Robotic exoskeletons are wearable devices made of mechanical and sometimes electrical technologies that are used to enhance the physical performance of the wearer or act as orthotic devices for gait rehabilitation or locomotion assistance. Depending on the purpose they serve, human robotic exoskeletons can be made from materials such as carbon fiber and metal, or they can be made entirely out of soft and elastic parts. Some exoskeletons need to be tailored to the individual that is using them and have adjustable hardware to fulfill that need. Overall, the technology behind the exoskeleton depends largely on its type and function.

Exoskeletons can be considered powered, using technology like sensors and actuators, or passive, using purely mechanical parts. The electronics with which powered exoskeletons are equipped register how much force is being applied to any given action, allowing the exoskeleton to share some of that burden with the user. Passive exoskeletons take the weight from the body’s extremities and distribute it to the core or leg muscles, spreading the weight out to relieve pressure from the targeted body part. This prevents fatigue from occurring as quickly and lowers the chances of strain or injury.

Groups That Benefit From Exoskeletons

Human robotic exoskeletons can be used for the purpose of health, industrial labor, and military research and development. For health, exoskeletons can be used to restore someone’s limb functionality and help them to walk again.

Instances of health-related applications for exoskeletons include stroke, spinal cord injury, acquired and traumatic brain injury, muscular dystrophy, cerebral palsy, orthopedic injury, Guillain barre, brachial plexus injuries, multiple sclerosis. These diagnoses can result in a range of impairments including monoplegia, hemiplegia, paraplegia, quadriplegia, ataxia, and other weaknesses. Benefits of exoskeletons used in the healthcare field include: increased user independence, decreased chronic pain, reduction of energy required for movement, increased range of motion and endurance, increased quality of life, and more.

Patients with lower extremity mobility loss can enlist the help of lower body exoskeletons to address gait inefficiencies by supporting the spine, trunk, and legs including hip, knee, and ankle joints. In this instance, the exoskeleton promotes correct movement patterns in all phases of physical rehabilitation and challenges patients as they progress towards walking back into their communities.

Patients with upper extremity mobility loss can wear upper-extremity exoskeletons designed to assist their affected shoulder and arm during rehabilitation, resulting in rehabilitation sessions with a higher dosage, more intense therapy, and a wider active range of motion. An exoskeleton can provide access to the shoulder joint and scapula to help therapists facilitate movement while the device supports the patient’s arm with minimal interference, allowing for a natural motion.

For patients with acquired brain injury and stroke, lower-extremity robotic exoskeletons are utilized by physical therapists to improve patients’ orientation to midline, weight shift, stepping quality, and lower extremity muscle strength. These exoskeletons utilize the principles of neuroplasticity to help physical therapists deliver high quality, intense, repetitive, task-specific practice to patients on their journey of reclaiming independence.

Patients with spinal cord injury exhibit a wide range of potential symptoms including: extreme pain in the neck, back, or head, urinary or bowel urgency, retention, or incontinence, abnormal band-like sensations in the thorax, impaired breathing, weakness or paralysis in upper and/or lower extremities. The use of a robotic exoskeleton can help to significantly alleviate these symptoms or, in some cases, eliminate them. The patient wears a backpack-like support which connects to robotic leg-support structures and attaches comfortably to the waist, hips, legs, and feet. This helps to support the body and protect joints during preGait and gait training.

Those who suffer from loss of mobility after a stroke or ABI can wear a robotic exoskeleton, which provides therapists the opportunity to retrain their muscles and brains to regain lost mobility. This has proven to be successful in helping thousands of patients leave their wheelchairs or walkers behind. The 2022 clinical trial (WISE), performed by The International Spinal Cord Society, focused on a 12-week exoskeleton-based robotic gait training regimen to track clinically meaningful improvement in independent gait speed among participants with chronic incomplete spinal cord injury (iSCI). The results showed that the proportion of change in the clinical ambulation category was highest among participants in the group using exoskeletons developed by Ekso Bionics. 5 of 9 participants in the “Ekso group” exhibited the greatest change in ambulation status. In comparison, only 3 of 10 within the Active Control group showed improvement in the ambulation category, and 0 of 6 in the Passive Control group displayed any meaningful change (between group difference in proportions p < 0.05, Table 5).

For the prevention of injury rather than recovery from it, those working in industrial settings such as construction and manufacturing benefit significantly from exoskeleton technology. For industrial application, exoskeletons are designed to increase productivity and reduce fatigue, with the goal of eliminating work-related injuries to the neck, shoulder, and back.

Types of Mobility Exoskeletons Target

Exoskeletons can target mobility nearly anywhere on your body—your ankles, knees, shoulders, and so on. They are generally divided into two segments: lower body and upper body.

Lower body exoskeletons are engineered for patients suffering from lower extremity paralysis or weakness and offer postural trunk support as well as support at the knee, hip, and ankle. In doing so, they may help the wearer regain their natural walking ability.

Upper body exoskeletons are designed to assist a patient’s affected shoulder or arm and have been a revolution in upper limb rehabilitation. Engineered for patients suffering from upper extremity paralysis or weakness, upper exoskeletons help patients recover strength, endurance, and range of motion.

7 Ways Exoskeletons Help Regain Mobility

1. Posture support

Posture has a significant impact on movement patterns and is directly correlated with a person’s ability to walk. A rigid component on the back of an exoskeleton offers support for patients with decreased trunk control. This helps them bear their own weight with proper postural alignment for maximized treatment time. Your posture is a central part of your body’s functionality, affecting the way both your upper body and lower body move, so this level of support is non-negotiable when it comes to regaining mobility.

2. Adaptive Gait Training

Sensors and software components of the exoskeleton continuously monitor and regulate leg movement. If a patient is leaning, the exoskeleton will automatically detect it and provide feedback that their physical therapist can use to help improve their balance and gait. The device and therapist work in conjunction to keep patients from compensating to avoid discomfort and achieve faster results.

3. Pre-ambulatory tools

It’s commonly known that balance plays a big role in maintaining successful mobility. If you’re struggling to keep your weight centered, walking is going to be a challenge to say the least. The pre-ambulatory tools are a suite of programs dedicated to helping patients balance, weight shift, squat, and step in place before walking. The squat function can also be used as an advanced feature to challenge patients in strengthening lower extremities.

4. Feedback

Resuming natural step length and swing symmetry is one of the most common goals in rehabilitation. Without proper symmetry, walking is possible. However, loss of symmetry would make walking difficult, could delay progress, and require an uncomfortable amount of effort to achieve movement. Real-time feedback helps patients regain proper step length and swing symmetry in hopes of restoring their ability to walk naturally and with ease.

5. Data

Regaining mobility shouldn’t be a guessing game. In order to make the necessary improvements for resuming natural mobility, a patient needs to be able to build on successes and correct any irregularities. Data tracking allows for this by showing session-specific walking time, distance, and speed in addition to symmetry, securely saved to a cloud-based dashboard for easier analytics. With smart data capture and clinician controls, medical professionals can evaluate patients and their training sessions in real-time to best help each individual on their road to recovery.

6. Assisted Motion

By providing the proper support, exoskeletons can boost the range of motion being used to regain mobility. For example, the Ekso Bionics upper-extremity exoskeleton offers assistance to the shoulder and arm on all planes. As a result, the patient can exercise 180 degrees of motion where they otherwise may not be able. It also allows for a more natural movement pattern by supporting the limbs with minimal interference.

7. Robotic Powered Movement

With powered exoskeletons, the robotic power itself can drive significant results in the process of regaining mobility. The bionic components can provide total support and trajectory assistance for patients with complete paralysis. Patient-initiated movements can be used to encourage muscle activity for those with remaining strength and the sensors will register that initiation and assist the patient in carrying out the movement – only as much as the patient requires.

Alternative Methods of Treatment Alongside Exoskeletons

Depending on the diagnosis that led to a loss of mobility, there are a number of different kinds of treatment approaches that your physical therapist may use in conjunction with the use of exoskeleton technology to aid in the rehabilitation process.

Individuals with loss in mobility due to disease or an injury sustained by the nervous system may need a physical therapist who specializes in neurology to evaluate and contribute to a full recovery.

Elderly patients, whose mobility is declining due to age, may benefit from geriatrics in addition to their exoskeleton treatment. Likewise, adolescents with inherited illnesses or injuries should supplement their exoskeleton treatment with physical therapists who specialize in pediatrics. There are also specialized therapists for sports-related injuries and women’s health.

Why Choose Ekso Bionics Exoskeletons?

Since 2005, Ekso Bionics has used exoskeleton technology to enhance natural abilities and improve quality of life. We are the leading exoskeleton company to offer technologies that help those with paralysis stand up and walk, enhance worker capabilities globally, and provide research for the advancement of R&D projects intended to benefit U.S. defense capabilities.

As the first exoskeleton FDA-cleared for acquired brain injury, stroke, and spinal cord injury, EksoNR offers the industry’s most natural gait, re-teaching the brain and muscles how to properly walk again.

Conclusion

If you or a loved one is suffering from imparied mobility after a stroke, brain injury, or spinal cord injury do not hesitate to get the best possible care. Consider the pros and cons of using human robotic  exoskeletons in the rehabilitation process and do your research to find out if they are right for you.

As one of the top trends in the health and tech industries today, human robotic exoskeletons are reshaping our approach to both medical treatment and industrial labor. On one hand, robotic exoskeletons are bringing hope to people across the world who are dealing with the loss of mobility and independence or suffering from paralysis after a stroke, brain injury, or spinal cord injury. On the other hand, they are enhancing worker capabilities beyond what was previously thought possible. Considering the nature of their advantages, it shouldn’t come as a surprise that they are also being used in military research and development.

What are Human Robotic Exoskeletons?

Human robotic exoskeletons are mechanically made, taking a user’s anatomy into consideration, to improve mobility and endurance. They involve the application of robotics and bio-mechatronics — a study of science that merges biology with “mechatronics”, a discipline at the crossroads of electronics, mechanics, and computing. The focus of this groundbreaking technology is to increase bodily independence and effectiveness. It is designed to assist humans by enhancing, reinforcing, or restoring, depending on the circumstances, an individual’s physical performance. Human robotic exoskeletons can also work to reduce the energy it takes to move joints, making repetitive tasks easier, and also work to improve human movement in cases of mobility loss.

The earliest work related to human robotic exoskeletons was much earlier than you might think. A Russian inventor named Nicholas Yagn had the first approved patent for a powered exoskeleton in 1890. It was a spring-operated device designed for the military with the intention of enhancing a user’s ability to run and jump, but it never made it past the drawing board.

It wasn’t until the 20th century that robotic exoskeletons were actually assembled. In 1960, General Electric created the Hardiman, or “Human Augmentation Research and Development Investigation” and “MANipulator”, a 1,500-pound machine produced with military funding. Unfortunately, the machine was too large and too heavy to operate properly and the project was discarded altogether.

Finally, around the year 2000 came BLEEX (Berkeley Lower Extremity Exoskeleton), a pair of robotic legs designed by engineers at UC Berkeley and funded by DARPA (Defense Advanced Research Project Agency) aimed at lessening the effort it takes to carry heavy loads over long stretches.

Today, robotic exoskeletons have become more prevalent and complex, with an array of functions and uses. Companies like Ekso Bionics have designed exoskeletons for the purpose of military research, assisting industrial labor, and aiding neurorehabilitation.

Components of Human Robotic Exoskeletons

Robotic exoskeletons made for humans may look different depending on the functions they serve. Exoskeletons can be made from materials such as carbon fiber, metal, and elastic. Their coverage also varies from the entire body, to lower or upper extremities, or to a specific body part like the shoulder, hip, or ankle. Some exoskeletons have adjustable hardware so they can be tailored to the individual that is using them. Overall, the technology behind the exoskeleton depends largely on its type and function.

There are two types of exoskeletons: powered and passive.

Powered exoskeletons are equipped with electronics that register how much force is being applied to any given action, allowing the exoskeleton to share some of that burden with the user. In order for the exoskeleton to work properly, there must be technologies to support the three modules: sense, decision, and execution. These technologies include sensors, actuators, mechanical structures, algorithms, and control strategies that gather necessary information for carrying out each action. It may sound complicated, but it’s actually fairly straightforward. There are three basic steps that accompany the three modules.

• The sense module is where the information gathering takes place. The exoskeleton records data from the user via the device sensors.
• Next, the decision module interprets that data and sorts it into the intended activities.
• Finally, the execution module provides the mechanical power to complete the task.

Examples of the lower-extremity powered exoskeleton at Ekso Bionics:

• Data capture

This feature allows the user to view session-specific walking time, distance, and speed. It also securely saves this information into a cloud-based dashboard for easier analytics.

• Clinician control:

This feature allows the clinician to set certain parameters they can use to help better assist their patient, ushc as training targets and step parameters.

• Smartassist software:

This feature allows the clinician to customize motor support  independently on each leg for various impairment levels, from full assistance to patient-initiated movement, in both swing and stance phases of walking.

• Adaptive gait training:

This feature consists of sensors and software continuously monitoring and regulating leg movement to minimize compensatory gait patterns.

• Pre-ambulatory tools:

The feature possesses a program suite called preGait that consists of programs that help patients balance, weight shift, squat, and step in place before walking.

To contrast with the lower-extremity exoskeleton, here are the features of the upper-extremity exoskeleton vest for construction at Ekso Bionics:

• Mobility Structure

The exoskeleton vest was built with a patented stacked-link structure that seamlessly follows the user’s arm and elbow through the full range of motion while providing proper joint alignment through repetitive movement.

• Extreme logistics positions

These positions include reaching directly overhead, across the body, or even into a back pocket for a phone — are unrestricted with this wearable exoskeleton.

• Adjustable, high-force actuators

These actuators are proven to be extremely durable with over a million cycles before requiring replacement.

• Customized Assistance Levels

The level of each device can be adjusted for the user and task by easily swapping out the set of compact gas springs. Different levels can even be selected for each arm independently depending on the task.

Passive exoskeletons are purely mechanical, providing support using pulleys, a spring balancer, and weights to counterbalance the workload. Passive systems generally take the weight off the user’s shoulders and arms and transfer it to their center of gravity so that the user obtains increased endurance during overhead tasks and other demanding work.

Exoskeleton technology not only helps the individual perform tasks that directly aid in increasing mobility, but also provides medical professionals with the information needed to offer treatment with a higher chance of success. For patients with a low likelihood of regaining their mobility, these machines can be a saving grace, in many cases enabling full rehabilitation.

Exoskeletons for Rehabilitation

Diseases or injuries that can be treated with physical therapy and a wearable exoskeleton include but are not limited to: stroke, spinal cord injury, traumatic brain injury, aneurysm, hypoxia/anoxia, ischemia, brain tumor, or any other acquired brain injury. For individuals recovering from these injuries, exoskeletons are great for rehabilitation and mobility restoration. Exoskeletons have the potential to bring these patients from lower limb disability and complete loss of movement all the way to the point of getting out of their wheelchairs, and learning to walk again. One study from 2015 found that, “The ability to restore gait for individuals with paraplegia has improved with progress in various powered exoskeletons and neuromuscular stimulation technologies. The powered exoskeletons are able to restore the stand up, sit down, and walking motions.” These human-augmenting devices are truly a rehab tool for physical therapists to challenge their patients, requiring active participation known to drive brain plasticity.

Exoskeletons for Upper Extremity Therapy

Upper-extremity rehabilitation exoskeletons assist physical therapists, occupational therapists, physiatrists, and doctors in clinically rehabilitating patients with upper-body weakness or paralysis. This new technology also greatly benefits industrial applications and other workplace settings or job sites. Wearable exoskeletons help workers complete tasks with full range of motion rather than giving in to fatigue, overuse, or repetitive movements.

An injury resulting in decrease of upper-body strength can come from any number of areas whether that be occupation risks, sport injury, or illness. An upper-body exoskeleton is a wearable vest that helps you perform everyday tasks and use your arms and shoulders without limitations. There are a few different reasons why someone may benefit from upper-extremity therapy and bionics. Some conditions EksoUE is beneficial for include: stroke, spinal cord injury, traumatic brain injury, muscular dystrophy, ataxia, orthopedic injury, Guillain barre, brain tumor, brachial plexus injuries, and other upper-extremity weakness or paralysis. Rehabilitative treatments may begin immediately post-injury or after any chance of reversing the damage through medical means has passed. These treatments are designed to strengthen weakened muscles, reteach parts of the brain to take over for the damaged areas, and help the patient adapt to a new way of doing things.

Exoskeletons for Lower Extremity Therapy

Exoskeletons for lower extremity therapy are appropriate for many people recovering from spinal cord injury, stroke, and brain injury at any stage of in-patient or outpatient rehabilitation, preferably as soon as possible after diagnosis. It can be helpful for patients to stand and take their first steps post-injury and retrain brain and muscle function as they learn to walk again. It can also help fine-tune walking skills and help improve patients’ gait as they learn to regulate their movements.

With this tool, patients have the opportunity to gain as many lost abilities as possible. The exoskeleton provides progressive levels of support so the clinician can reduce the assistance the system offers patients as they improve, and can even add resistance to one or both legs. Patients who use a wheelchair can use the exoskeleton to regain the ability to stand, retraining muscles to support body weight without strain. Therapists toggle between patient-initiated and therapist-initiated movement, tailoring rehabilitation to the patient.

Human Robotics for Industrial Labor

Industrial workers in construction or manufacturing benefit from a significantly lower likelihood of injury and increased quality of work by using exoskeletons to enhance their physical capabilities. Mechanical arms and vests help them lift heavy loads and perform repetitive tasks through an active range of motion so they can avoid giving in to fatigue and/or injury.

Why Choose Ekso Bionics for Human Robotic Exoskeletons?

Ekso Bionics is the leader in exoskeleton technology with the first FDA-cleared exoskeleton for both stroke and SCI in addition to acquired brain injury. With more than 175 conference presentations, chapters, and published articles, Ekso is the most widely-studied exoskeleton for rehabilitation, progressing patients far beyond what they would otherwise be able to accomplish. Our exoskeletons are backed by data from over 40 industry-leading research partners and help those with paralysis to stand up and walk, enhance worker capabilities globally, and provide research for the advancement of R&D projects intended to benefit U.S. defense capabilities.

Industries Ekso Bionics Specializes In

EksoHealth is the arm of Ekso Bionics that specializes in neurorehabilitation. We have helped thousands of patients with lower extremity disabilities take over 180 million Ekso-aided steps and have inspired an entirely new medical device industry. Similarly, we have helped many patients with upper extremity disabilities, allowing them to achieve rehab sessions with a higher dosage, more intense therapy, and a wider active range of motion.

EksoWorks is the arm of Ekso Bionics that specializes in our exoskeleton technology for industrial applications. Our EksoWorks upper-body lifting exoskeletons were designed to increase productivity and reduce fatigue, with the goal of eliminating work-related injuries to the neck, shoulder, and back.

Conclusion

Whether you’re looking to regain mobility, increase your capabilities on the job, or prevent injuries, human robotic exoskeletons are a reliable and technologically safe choice. We hope our exoskeletons provide you support and progress in rehabilitation and lower the number of worker-related injuries for years to come.

Strokes are the fifth leading cause of death in the United States and a major cause of long-term disability. Thankfully, great strides have been made in treating patients who have had strokes and been left with a disability. Ekso Bionics is leading the way with robotic exoskeletons to help those who have lost mobility due to stroke, spinal cord injury, or brain injury regain what they have lost.

What Is a Stroke?

A stroke occurs when part of the brain is deprived of oxygen. This can be caused by a blood clot blocking blood flow or by a rupture in the artery feeding blood to that part of the brain. Either way, if blood flow is not returned to the affected part of the brain quickly, the damage to the brain can become permanent. This can result in varying degrees of disability or death. 

There is also a type of stroke that is temporary. Known as a transient ischemic attack (TIA), these happen when the blood supply to the brain is cut off for only a short time. After experiencing a TIA, a patient may become clumsy or confused, but the effects are only temporary. Once blood flow returns to the brain, the effects of the TIA dissipate. It is still vital to see a doctor after having a TIA. People who frequently have these attacks may have a full-blown stroke later on. 

Immediate treatment can sometimes reverse the effects of a stroke. In the case of permanent stroke damage, rehabilitation with EksoNR exoskeleton can successfully return patients to a lifestyle similar to the one they enjoyed previously.  You can read more about the research on EksoNR and stroke in our Clinical Summary. This transformative device has been helping adults of all ages regain their mobility and their quality of life.

Health Effects of a Stroke

Because the brain controls almost all of our bodily functions, the range of effects from a stroke is very broad. Frequently, patients who have had a stroke have complete or partial paralysis to one side of their body, including the facial muscles. This can manifest as drooping eyelids, an inability to speak or chew food properly, and reduced mobility. 

Sometimes strokes do not affect a person’s limbs and muscles but rather the parts of the brain that control thinking, speech, hearing, or eyesight. In these cases, a patient may have a diminished ability to think clearly or logically. They may show personality changes or lose their memory. If the areas of the brain that control the senses are damaged, the result may be loss of taste, smell, hearing, or sight. 

Even with advances in understanding strokes, it is still somewhat unpredictable how a stroke will affect someone. If the patient’s symptoms include decreased mobility, even if it is severe, EksoNR robotic exoskeleton can be a powerful tool for reversing this potentially life altering side effect.

Stroke Treatments 

Stroke treatments fit into two categories: preventative treatments and rehabilitative treatments to regain what was lost. 

Preventative Stroke Treatments 

Immediate stroke treatments vary depending on how the stroke occurred. If a blood clot caused the stroke, then medications will be given to thin the blood and reduce the size of the clot. If a rupture or other brain bleed caused the stroke, steps would be taken to stop the bleeding and return blood flow to that part of the brain. 

In both instances, medication is often given to reduce the patient’s blood pressure. High blood pressure can be both a cause and a result of a stroke. 

Rehabilitative Stroke Treatments 

Rehabilitative stroke treatments begin after any chance of reversing the damage through medical means has passed. These treatments are designed to strengthen weakened muscles, reteach parts of the brain to take over for the damaged areas, and help the patient adapt to a new way of doing things. While physical, speech, and occupational therapy is a part of these treatments, new technology, like EksoNR, gives patients who have had a stroke that resulted in paralysis or loss of mobility more options, and hope. 
 

EksoNR is a robotic exoskeleton that the Food and Drug Administration has cleared for rehabilitation after stroke. It provides therapists the opportunity to work with patients’ brain plasticity and retrain their muscles and brains to regain lost mobility.  It has shown great success at helping thousands of patients leave their wheelchairs or walkers behind. 

EksoNR can be utilized both in walking and preGait modes. Pre-gait activities include those that work on balance, midline orientation, and prepare a patient for walking. 

The various gait-training modes offer support to the torso, hips, knees, and ankles while keeping the patient in a fully upright posture and providing varying amounts of power to one or both legs. EksoNR uses a gyroscope, sensors, and software that monitors the position of the EksoNR to ensure that training is done effectively and safely. As a patient progresses and regains midline orientation, coordination, and strength, EksoNR will reduce the output of power allowing the patient to progress so they can walk out of the device. 

The patients who use EksoNR exoskeletons post-stroke are kept apprised of their progress and must actively participate in the process to succeed. This might look like assisting with weight shifts, and may progress to the patient controlling all aspects of the steps they are taking. This involvement and positive progress reports can have a profound psychological effect on the patients, increasing their odds of improving outcomes.