Category: Exoskeletons

A stroke is a medical emergency, capable of damaging the brain through interruption of its blood supply. There are many symptoms of stroke including difficulties walking, speaking, and understanding, as well as numbness of the face, arm, or leg. When it comes to treating subacute stroke in an inpatient rehabilitation setting, Dr. Crissy Voigtmann (Doctor of Physical Therapy and board-certified Neurological Clinical Specialist), Dr. CJ Curran (Doctor of Physical Therapy, certified brain injury specialist and board-certified Neurological Clinical Specialist), and Jose Dominguez (Director of Rehabilitation, Orlando Health) give professional insight on EksoNR, the first FDA-cleared exoskeleton for stroke and spinal cord injury, and the only FDA-cleared exoskeleton for acquired brain injury.

Orlando Health ORMC Institute for Advanced Rehabilitation (IAR) is a CARF accredited inpatient and outpatient rehab unit partnered with Ekso Bionics since 2019. Currently, they have four Level-Two trained therapists at the inpatient rehabilitation, and two Level-Two trained therapists at their outpatient rehabilitation.

What is EksoNR?

Currently, EksoNR is the only exoskeleton that is FDA-cleared for acquired brain injury. It is the first FDA-cleared exoskeleton and extremely adaptive with short-term implications as well as long-term ones. The device is capable of progressing through programming as a stroke patient progresses in recovery. This gives the long-term capability to adapt from session to session, not only for patients with strokes but spinal cord injuries or TBI.

Who can benefit from EksoNR?

In 2020, IFR had 310 stroke patients arrive at the unit. On average, they had a 1.58 acuity level, based on a case-mix index equation that determines the acuity level for inpatient rehab. Typically a stroke patient stayed at the unit for 15.7 days. In order to determine mobility scores upon admission, Crissy and CJ used Care (formerly known as FIM), which is a standardized test that all inpatient rehabilitation facilities have to use for all diagnoses. 

Additional Care scores from the facility include:

• Average Care Score: 2.9 (Max Assist)
• Average Walking Score (per 50ft): 2.2 (Max Assist)
• Average Walking Score (per 150ft): 1.7 (Total Assist)
• Average Stair Score: 1.2 (Total Assist)

At IAR, these scores were what the average numbers looked like for all stroke patients and are important to know to where those who used Ekso started from at baseline. 

[The following is condensed from the full webinar of Dr. Crissy Voigtmann and Dr. CJ Curran.]

What were the deciding factors in having Ekso a part of the program at Orlando Health?

As Dr. Crissy Voigtmann and Dr. CJ Curran were in the decision-making process of having Ekso become a part of their program, they were asking themselves: “Are we doing enough? Are we providing these patients with enough repetitions at a high enough intensity level to elicit the neural change that needs to happen during this short length of stay that we have?”

In general, the answer to the questions they asked was no. They ultimately decided there was not an exact dosage that has been established for intensity or for repetition, but there was a growing body of evidence that demonstrates for gait in particular; that stepping practice needs to be in the thousands a day for optimal improvement.

Observational studies have shown that in inpatient rehab facilities (places that have stroke programs), stroke patients are taking an average of 250 steps a day. To further reinforce that point, these same studies have shown that stroke patients on average spend greater than 50% of the day in bed and greater than 60% of their time alone. 

Not only were they not utilizing the active time with these folks to provide high-intensity therapy that is necessary for neural training, but even during the passive time, they realized they were not providing the necessary environment, whether it be with engagement or stimulation that is necessary for improvement as well. 

They determined the best solution was integrating Ekso into their program. This was the bridge. This bridged the gap between that dilemma and that solution. For them, Ekso allowed them to accomplish those goals on day one and early, especially for their folks who are significantly impaired, the ones with a lot of deficits. These were folks, in their experience, that are really difficult to gait train. These are the people that unfortunately tend to fall through the cracks and would get low level therapy or low intensity therapy otherwise.

How has Ekso changed training for the patients?

Because of Ekso, they were able to get individuals up early and on their feet for extended periods of time, participating in high-intensity therapy from the very beginning. There are certain positions that would take two or three therapists, or three pairs of hands, to get a patient to accomplish. But one therapist is able to do it whilst focusing on other deficits as well, thanks to Ekso.

Who are the candidates for Ekso?

The stroke patients primarily receiving early Ekso intervention:

• Dense Hemiparesis: 0-⅖ MMT throughout affected lower extremity
• Pusher Syndrome
• Significant Postural Control and Awareness deficits
• Motor planning and Sequencing deficits

Other patient specific factors leading to early Ekso utilization:

• Obesity/Height (under 220lbs, under 6’5” approximately) 
• Impulsivity
• Cognitive deficits 

The overall message is these patients are individuals who are very difficult to manually facilitate. They are very difficult to provide the manual techniques that are necessary to hit high repetitions or to hit high intensity levels. As a result, they are going into the exoskeleton. 

Stay Tuned For More Blogs About EksoNR or  Click Here to View The Webinar in Full 

[The following is condensed from the full webinar of Dr. Crissy Voigtmann and Dr. CJ Curran.]

The Institute For Advanced Rehabilitation (IFR, Orlando Health) is a CARF accredited inpatient and outpatient rehab unit partnered with Ekso Bionics in 2019. With the utilization of EksoNR (the first FDA cleared exoskeleton) in the rehabilitation of patients, they were able to narrow down the typical patient profile and measure their progression via outcomes from using EksoNR.

Average Stroke Patient Statistics 

The following data represents the “average” scoring of all of their 310 stroke patients. It is provided so that anyone may look over and compare this data with those they tended to put into the exoskeleton. When patients are referred to as going into the exoskeleton, please note that it means at the exoskeleton’s maximum assistance level.

Now, their outcome measures. The postural assessment scale for stroke (PASS) is a stroke specific outcome measure that is determined by movement of the patient: they’re sitting, they’re rolling in bed, they’re standing, and then picking up something off the floor, as well as single limb stance. Typically that score is out of 36. Their average PASS score on admission for all patients with stroke was a 20.7, which indicates significant deficit. 12.4 is the average PASS score for their stroke patients going into Ekso, so they are even more impaired than the average patient they saw on the floor. 

The Berg is out of 56 with the benchmark being 45; you can see the patients come in a lot lower level than that at 16.6. The Berg for the exoskeleton candidates is 4.9, meaning they can sit and maybe be transferred by one person – that’s generally a five out of 56 on the Berg. Some patients who get into the exoskeleton can sit independently and some cannot; again, as you can see reflected in the data, their gait is almost not a gait. It is very, very slow, 0.04 meters per second, if they are even ambulatory.

Average Care Score for Mobility on Admission for all CVA:

Transfers: 2.9

Gait: 2.2 for 50 feet and 1.7 for 150 feet

Stairs: 1.2

Average Outcome Measure Performance on day of evaluation for all CVA

PASS: 20.7

BBS: 16.6

10 MWT: 0.24 m/s Self Selected Speed and .33 m/s Fast Speed

Average Care Score for mobility on admission for patients using ekso:

Transfers: Total (1)

Gait: Total (1) for all ambulation

Stairs: Total (1)

Average Outcome Measure Performance on day of evaluation for patients using Ekso

PASS: 12.4

BBS: 4.9

10 MWT: 0.04 m/s Self Selected Speed and 0.04 m/s Fast Speed

How often is the exoskeleton used on the floor?

Generally, given that their length of stay is about 15 days, they were (on average) getting people into the exoskeleton four times during their stay.  However, that really depends on the type of patient and their situation. They have had people in as many as 12 times during their stay.

The average number of total steps taken per patient during their stay is 1,354 with an up and walking total of at least 11 minutes per session, but the average uptime is more than half the session. That means more than half of the session is where the patient is actually standing and in a weight bearing position. They may be working on pre-gait activities. They may be working on just standing tolerance and co-treating with OT or speech. So they do utilize it longer than that 11 minutes, but that’s active walking time.

What were the deciding factors in having Ekso a part of the program at Orlando Health?

As Dr. Crissy Voigtmann and Dr. CJ Curran were in the decision-making process of having Ekso become a part of their program, they were asking themselves: “Are we doing enough? Are we providing these patients with enough repetitions at a high enough intensity level to elicit the neural change that needs to happen during this short length of stay that we have?”

In general, the answer to the questions they asked was no. They ultimately decided there was not an exact dosage that has been established for intensity or for repetition, but there was a growing body of evidence that demonstrates for gait in particular; that stepping practice needs to be in the thousands a day for optimal improvement.

Observational studies have shown that in inpatient rehab facilities (places that have stroke programs), stroke patients are taking an average of 250 steps a day. To further reinforce that point, these same studies have shown that stroke patients on average spend greater than 50% of the day in bed and greater than 60% of their time alone. 

Not only were they not utilizing the active time with these folks to provide high-intensity therapy that is necessary for neural training, but even during the passive time, they realized they were not providing the necessary environment, whether it be with engagement or stimulation that is necessary for improvement as well. 

They determined the best solution was integrating Ekso into their program. This was the bridge. This bridged the gap between that dilemma and that solution. For them, Ekso allowed them to accomplish those goals on day one and early, especially for their folks who are significantly impaired, the ones with a lot of deficits. These were folks, in their experience, that are really difficult to gait train. These are the people that unfortunately tend to fall through the cracks and would get low level therapy or low intensity therapy otherwise.

A Case Study with EksoNR

Almost 60% of the patients are stroke patients. They found that the EksoNR does such a good job, that typically they’re ambulatory at the end of their rehabilitation, and they move on to their outpatient clinic. An incomplete spinal cord would be their second highest diagnosis in terms of volume. 

Take into consideration the progress of one of their patients, Sarah. She is a 62 year old female. She had multiple ischemic strokes in her right hemisphere. She also presented with pusher syndrome. With pusher syndrome, the difficulties that arise in therapy are because of misunderstanding of midline orientation: they are persistently laterally leaning, and/or they’re pushing themselves over onto their weak side. This is very challenging to treat because they are going towards a limb that is hemiperetic and does not support their body. Just getting that patient to take a step is difficult because their weight shifting is so impaired.

Sarah is also a tall and large woman, which makes it even harder for a therapist to facilitate gait. She had left neglect. Her admission was very early after her stroke, just five days post-stroke, so all of the therapy was new for her. In addition to her challenges, she was also a braille user.

Her admitting outcome measure scores PASSwas a 12 out of 36, and she was non-ambulatory, requiring maximal assistance for her bed mobility and her transfers, while being dependent for gait. They were able to get her in the Ekso three times. She didn’t take a ton of steps. They were a little bit limited in her length of stay and her time, but these steps were very effective and these sessions were very effective. They allowed the exoskeleton to facilitate those steps. When they put on the Ekso, it was just one therapist and the tech or an aide. They were able to spend more time standing doing pre-gait. The clinicians were treating that pusher syndrome by having her shift her weight onto her limb more. They recall that was a significant moment for this patient.

The data for her outcome scores are below so that you can compare her admission to her discharge:

Admission:

BBS: 5/56

PASS: 12/36

10 MTW: 0m/s

Max A bed mobility and transfers; dependent for gait

Discharge:

BBS: 17/56

PASS: 29/36

10 MTW: SS 0.15m/s; FP 0.15m/s

SBA Bed Mobility, SBA for 10 feet of gait and transfers, Min A gait >150 feet and 4 stairs

Crissy Voigtmann received her Doctor of Physical Therapy from the University of St. Augustine in 2014. She’s a board certified neurologic clinical specialist. She works as a full-time clinician serving patients with brain injury, stroke, neuro oncology, and incomplete spinal cord injury, and spearheads program development for locomotor training for all neurologic patients in the inpatient rehab setting at Orlando Health’s Institute for Advanced Rehabilitation.

What were the first steps toward introducing EksoNR in a rehab program?

When the doctors at Orlando Health first got the exoskeleton, they were collaborating and came up with this idea of having a lead locomotor person.  Dr. Voigtmann became the lead person just to help bridge the gap between their non-Ekso therapists on the floor, with either pairing them with an Ekso therapist or with Dr. Voigtmann herself. They were afforded that ability just by creating the role of lead locomotor therapist at the clinic.

The other first step was a designated area off to the side of the gym, so that the exoskeleton has everything there that it needs.  There you will find all evaluation forms and data collection sheets and the measuring tools. Everything is in one spot, so that if someone thinks, “This is a great patient for Ekso. I want to do quick measurements,” the opportunity is available to them. They get that patient on the mat, take the measurements, and that allows them the opportunity to get the patient into the Ekso the next session if the current session is unavailable. They have found that it is a nice way to keep everything in one place.

How do you refer patients to EksoNR?

They tried to come up with a referral system. For example, their unit has nine teams, so nine teams of PT/OT and they only have four Ekso-trained therapists. What do they do with the other teams? They paired up with an Ekso clinician in order to have the opportunity to propose, “Can we switch this patient off? You see one of mine and I’ll see one of yours.” With this method, they could optimize the number of patients getting into the exoskeleton and get the benefits of early gait training.

What else has helped EksoNR be successful in inpatient rehab?

At IFR, they have been very fortunate to have really engaged rehab aides in their unit. They went through training sessions with them on how to do wrenching techniques, how to size the Ekso, how to clean it, and even sometimes how to write down some of the data on a data collection sheet for them if time is critical.

They have been essential in the setup, the breakdown, and taking all of the information. They’re also really skilled at using the Ekso controller so that they don’t have to pull in too many more people. Essentially, there would be a physical therapist who is Ekso-certified and then a tech for each session. That really helps to make it effective; cost efficient for the company, and also time efficient.

Stay Tuned For More Blogs About EksoNR or  Click Here to View The Webinar in Full 

Who are the candidates for Ekso?

The stroke patients primarily receiving early Ekso intervention:

• Dense Hemiparesis: 0-⅖ MMT throughout affected lower extremity
• Pusher Syndrome
• Significant Postural Control and Awareness deficits
• Motor planning and Sequencing deficits

Other patient specific factors leading to early Ekso utilization:

• Obesity/Height (under 220lbs, under 6’5” approximately) 
• Impulsivity
• Cognitive deficits 

The overall message is these patients are individuals who are very difficult to manually facilitate. They are very difficult to provide the manual techniques that are necessary to hit high repetitions or to hit high intensity levels. As a result, they are going into the exoskeleton. 

Stay Tuned For More Blogs About EksoNR or  Click Here to View The Webinar in Full 

[The following is condensed from the full webinar of Dr. Crissy Voigtmann and Dr. CJ Curran.]

While EksoNR (the first FDA-cleared exoskeleton for ABI, stroke and spinal cord injury) is a technological advancement that has changed the way patients with stroke experience rehabilitation, it is not without its own difficulties. The Institute For Advanced Rehabilitation (IFR, Orlando Health), has been partnered with Ekso Bionics since 2019. Dr. Crissy Voigtmann and Dr. CJ Curran utilized EksoNR with certain patients and found some difficulties that they were not at first prepared for.

The Generation Gap

With stroke comes increased age. Typically speaking, some of the older individuals are not as comfortable with technology. It becomes very apparent once they get into EksoNR and they’re fearful. Their anxiety can become a pretty significant barrier to try to get them acclimated to this level of technology. Not only that, but also from a deficit standpoint, individuals that have attention deficits or engagement deficits just want to go along for the ride once they are in the suit, and it can be really tough to get them to actively engage in the process of their rehabilitation.

The patients are motivated, they want to do it, but as they tried to convey what the suit is capable of or what the progression looks like, some of the patients really struggle to grasp what that next step is or what that progression will be.

Another element that caught them off guard initially was incontinence. A lot of patients have not been up against gravity for an extended period of time in a while. That has been something that they have prepared for now, and especially in advance, before they even start the session(s).

How do you fix the challenges that patients face with EksoNR?

Luckily most of the issues faced are solved through individualized education, demonstration of the device, or even allowing the patients to observe other stroke patients get into the device and complete a gait training session. 

They have also implemented slow gradual exposure. Sometimes that looks like doing the evaluation, they get them up, and all they do for that session is weight shifting. It might not have been what the clinicians had planned that day, but it got then the buy-in they needed so that they could do a full gait training session the next day.

 As an inpatient rehab unit, they are very fortunate to work as an interdisciplinary team. Sometimes the solution has been doing co-treats with occupational therapy or with speech therapy, or even neuro-psychology depending on what the root causes for the difficulty of the patient to engage with the device and complete the session that they needed them to.

What are the most difficult barriers to overcome?

The patient specific barriers are the most obvious, but they have found that it’s sometimes the environmental or the clinical barriers that are the most difficult to overcome. Some environmental and clinical barriers can be as concrete or as tangible as spatial limitation, but they can also be as difficult to solve for a variety of different reasons such as scheduling issues or time constraints.

Stay Tuned For More Blogs About EksoNR or Click Here to View The Webinar in Full 

Many people with an acquired brain injury (ABI) are told they will never walk again. Fortunately, our newly developed, cutting-edge wearable robot EksoNR© has allowed many patients with ABI to regain their mobility.

‌EksoNR is a mechanized exoskeleton that aligns with the wearer’s anatomy to provide the support and assistance they need during rehabilitation. EksoNR is the first and only exoskeleton for ABI rehabilitation to be cleared by the FDA. It fits snugly over the patient’s legs, feet, hips, and waist to support their weight and joints.

‌Designed by clinicians for clinicians, EksoNR is the most widely studied rehabilitation exoskeleton available. As of July 2020, there are 74 completed clinical research studies and countless publications and white papers involving EksoNR. These studies contain the personal experiences of more than 1,800 participants around the world.

‌Read how EksoNR has helped one of our users regain her mobility and walk again.

Kylie’s Rehabilitation

After Kylie was injured in 2019, she went into a coma. According to Dr. Kenneth Shapiro, who specializes in Physical Medicine and Rehab, her condition was serious. She had an ABI in addition to multiple internal injuries. She recovered consciousness and soon began physical therapy. Kylie was able to regain amazing levels of self-initiated movement with the help of the EksoNR bionic exoskeleton.

‌Her physical therapist, Erin, related that Kylie regained much of her mobility using the EksoNR exoskeleton. “In the first session, we took maybe ten steps,” Erin shared. “And now she’s walking over 1,200 steps.” This sort of progress is spectacular in patients with ABI injuries. Considering the extent of Kylie’s injuries, this may not have been possible without EksoNR.

‌EksoNR has helped Kylie maintain her muscle condition and start walking again using the power of brain plasticity. With Erin’s guidance, Kylie worked on vital skills including shifting her weight, balancing, and improving her lower extremity muscle strength while wearing the device. As her gait became stronger and more confident, Kylie shifted from relying on EksoNR to using her own muscles to walk. Eventually, she only relied on EksoNR to correct any errors she madewhile walking.

How Does EksoNR Help ABI Patients Regain Their Ability to Walk?

Kylie’s story is a great illustration of how EksoNR can help people with ABI to stand and walk again.

Unlike many other exoskeletons, which provide all or nearly all of the power needed to walk, EksoNR is designed to challenge patients. With its high, stiff back and various progressive modes, EksoNR requires active participation in the rehabilitation process, so the patient can:

• Learn the most efficient and highest quality gait pattern
• Develop a natural gait with secure practice
• Improve their functional balance
• Improve gait speed 
• Improve walking distance

The following features also make EksoNR for ABI the ideal choice for patients to learn to walk again:

• Unique design helps the patient focus on movement and balance
• Data capture allows the physical therapist and patient to view session-specific speed, walking time, and distance. This information is saved securely in cloud storage for reference and analytics. It can be used by the physical therapist to provide personalized care.
• Clinician control lets the physical therapist set training goals and modify EksoNR’s support and assistance levels for each leg
• Adaptive gait training uses software and sensors to regulate and observe leg movement to promote gait development and strengthening
• Pre-ambulatory tools such as PreGait help patients balance, squat, weightshift, and step in place before walking
• SmartAssist software helps the physical therapist customize motor support depending on the patient’s impairment level.
  • This featured function allowed Kylie to move from full assistance to patient-initiated movement as she regained strength and coordination
• Posture support allows for easier and faster recovery by helping patients get started on their gait training sooner 

Physical therapists can also use EksoNR at any stage of outpatient or inpatient rehabilitation.

Edward Cruz, a physical therapist at the University of Texas Southwestern Medical Center, recounted Kylie’s case. He believes EksoNR is “a good intervention for early mobilization [that taps] into neuroplasticity expediently and more successfully,” compared to the body-weight support treadmills physical therapists often use for patients with ABI.

Learn More about EksoNR

To learn more about how EksoNR can help patients with ABI improve their gait and regain their mobility, request a demo for your practice.

‌EksoNR is only one of the many wearable exoskeletons that Ekso Bionics has developed for rehabilitation. Contact us today to learn more about how we can help your practice.

Many people with spinal cord injury (SCI) experience some kind of paralysis or weakness. They are often told that they will never regain their mobility.

‌However, our wearable robots have proven many of these assumptions wrong. By providing physical support to patients’ limbs and joints when they are relearning how to walk during the rehabilitation process, our wearable robots can give people who have experienced an SCI a sense of freedom as they regain mobility.

‌Our wearable robots train patients to walk as naturally as possible, rather than having them follow a more robotic gait pattern as with some exoskeleton suits. They also aim to improve and develop walking endurance and posture without harming or stressing other joints and muscles.

‌Ekso is available in more than 30 countries around the world and has helped thousands of patients take more than 130 million steps.

‌If you are interested in learning more about Ekso as one of the rehab options for spinal cord injury, contact a center near you to get started. Note, however, that our wearable robots are not for personal or home use and are available only in certified rehabilitation centers. This is to ensure that Ekso’s wearable robots are used safely and properly.

‌Find out more about how to rehabilitate SCI with our wearable robots below.

EksoNR©: Our Lower Extremity Exoskeleton

EksoNR© is our lower extremity medical exoskeleton and one of our rehab tools for spinal cord injury. The only exoskeleton to be cleared by the FDA for use on patients with SCI, stroke, and acquired brain injury, EksoNR is an effective way of retraining the muscles and reteaching the brain to walk.

‌With the help of EksoNR, patients will learn how to balance and walk again during rehabilitation after SCI. EksoNR also comes with powerful technology that calculates gait inefficiencies, which will help clinicians and physical therapists set goals and record patient progress.

‌Unlike some other exoskeletons, EksoNR promotes brain plasticity by challenging patients through active participation. Attaching comfortably to the thighs, hips, and waist, EksoNR is designed to be used with many different body shapes and sizes and fits patients under 220 pounds who are between 5 feet and 6 feet, 4 inches.)

EksoNR has the following features:

• Data capture. Allows viewing of session-specific walking time, speed, and distance. All data is saved onto a cloud-based dashboard.
• Long-lasting. Comes with two sets of rechargeable lithium-ion batteries, allowing for continuous use.
• Clinician control. Provides real-time modification of assistance levels for each leg based on session feedback and patient goals. It also sets training targets.
• SmartAssist software. Allows customization of motor support during swing and stance phases of walking for different levels of impairment, from full assistance to patient-initiated movement.
• Adaptive gait training. To minimize compensatory gait patterns, software and sensors constantly regulate and monitor leg movement.
• Posture support. EksoNR offers posture support with a high, rigid back and helps patients bear only their own weight with proper postural alignment. 
• Pre-ambulatory tools. EksoNR comes with preGait, a set of programs that help patients balance, step in place, squat, and weight shift before walking.

EksoUE©: Our Upper Extremity Exoskeleton

EksoUE© is an upper extremity wearable exoskeleton that fits snugly over the arm and shoulder. It gives patients a wider active range of motion with assistance in all planes.

‌Designed for patients with extremity weakness or paralysis due to SCI and other injuries, EksoUE helps patients recover and build strength, range of motion, and endurance. Lightweight and mobile, EksoUE can be used while sitting, moving, or standing.

EksoUE has the following features:

• Manual therapy access. Helps therapists facilitate movement by providing access to the scapula and shoulder joint.
• 180 degrees of assisted motion. Allows the patient to have a wider, more varied active range of motion and assists in all planes.
• Natural movement pattern. Allows for more natural movements than traditional therapy or other devices by supporting the patient’s arm with minimal interference.
• Multifaceted use cases. Can be used while moving around, standing, or sitting. EksoUE is not connected to static equipment, so it can be worn while doing daily activities, with other technologies, or gaming.
• Fully mechanical operation. Instead of being powered by batteries, EksoUE is spring-powered, allowing for continuous use without recharging.
• Increased workload. With EksoUE, patients can tolerate higher therapy dosages for longer periods.
• Adaptable ergonomics and assistance. Adaptable and easily reconfigured for different patient sizes and ability levels.
• Easy to set up and use. Includes a self-guided online course for therapists consisting of modules on both able-bodied individuals and patients.

Rehabilitation for brain injury depends on a thorough understanding of the neural damage involved. All traumatic brain injuries are ABIs, but not all ABIs are traumatic. Read on to find out what that means, and learn how our FDA-cleared EksoNR© robotic exoskeleton can help with recovery.

What Is an Acquired Brain Injury?

The Brain Injury Association of America defines an acquired brain injury as one that is “not hereditary, congenital, degenerative, or induced by birth trauma.” The injury changes the way neurons in the brain activate, ultimately altering the structure and function of brain cells.

‌ABIs can be traumatic or non-traumatic. The distinction is the cause of damage and whether it comes from inside or outside the body.

Traumatic Brain Injuries

A traumatic brain injury is a change in brain function due to an external force. An estimated 5.3 million people in the U.S. live with TBI-induced long-term disability, and up to 90,000 people join that cohort every year. The leading causes of TBI are:

• ‌Motor vehicle accidents
• ‌Suicidal attempts
• ‌Gun assaults
• ‌Falls

‌A TBI may develop from either a closed or open head injury or brain movement inside the skull.

‌An open injury penetrates the dura mater, the outermost membrane surrounding the brain and spinal cord. The penetrating object may be an external projectile or a broken piece of skull that enters the brain due to impact.

‌Closed (non-penetrating) injuries damage the brain without penetration of the skull or dura mater. These injuries can lead to dangerous intracranial pressure as the brain swells without room to expand. This swelling can cause further brain damage and increase the TBI’s severity.

‌A TBI may also develop if an incident jostles the brain within the skull. This is called traumatic inertial or non-contact injury. Falls, car accidents, and sports injuries are common causes of traumatic inertial injury.  

Non-Traumatic Brain Injuries

Non-traumatic brain injuries develop due to internal processes. Some arise suddenly, as in the case of oxygen deprivation. Others develop gradually due to illness or prolonged toxin exposure. Causes of non-traumatic brain injuries include:

• ‌Stroke
• ‌Aneurysm
• ‌Brain tumor
• ‌Infectious disease (encephalitis, meningitis, and others)
• ‌Near-drowning
• ‌Ongoing substance abuse

Effects of Acquired Brain Injuries

The effects of an ABI, whether traumatic or non-traumatic, depend on the brain damage’s location and severity. Many ABIs affect multiple body systems, including:

• ‌Thinking and behavior
• ‌Speech
• ‌Sensory abilities
• ‌Perception

‌‌ABIs, including TBIs, often result in impairments to a person’s mobility and activities of daily living. Recovery can be a long journey for patients and their family members, but our EksoNR exoskeleton for patients who have lost mobility or function can help many patients recover more completely.

Rehabilitation for Brain Injury

Treatment for an acquired brain injury can begin as soon as a medical professional has diagnosed the extent and effects of the illness or injury. Diagnosis typically involves scanning technology like computed tomography (CT) and magnetic resonance imaging (MRI).

‌Once the care team has confirmed the person to be medically stable, their rehabilitation can begin. Rehabilitation for brain injury involves some to all of the following components:

• ‌Physical therapy
• ‌Occupational therapy
• ‌Speech-language therapy
• ‌Neuropsychology

‌The goal is to help the person regain as many lost abilities as possible. EksoNR fits into the physical therapy aspect of rehabilitation.

EksoNR Robotic Exoskeleton

EksoNR helps people with ABI retrain their muscles and start walking again, using the power of brain plasticity. It’s the first and only wearable robotic skeleton to receive FDA clearance for ABI rehabilitation.

‌To use EksoNR, the patient wears a “backpack” supporting their torso connected to a robotic leg-support structure. The structure attaches comfortably to the patient’s waist, hips, legs, and feet, supporting their weight and joints. While wearing our robotic legs and following PT guidance, patients with ABI can work on vital skills like:

• ‌Orientation to midline
• ‌Weight shit
• ‌Stepping quality
• ‌Lower extremity muscle strength

‌The system features smart data capture and clinician controls so that medical professionals can customize their sessions to patient needs in real-time.

‌Physical therapists and other clinicians can use EksoNR at any stage of inpatient or outpatient rehabilitation. It can help someone stand up for the first time and take their first steps after ABI. 

As a person learns to walk again, EksoNR retrains their brain and muscles. It can also help someone with fine-tuning their walking skills, as they learn to regulate their movements and improve gait quality. 

To date, Ekso Bionics has positively impacted the lives of thousands thanks to over a decade of experience in the world of wearable bionics. Our wearable robotic exoskeleton is revolutionizing human potential in a variety of ways, all of which have already started to have a lasting impact on a broad array of fields. While many robotics companies are focused on developing bionics to help those dealing with paralysis or other movement-based disorders in  rehabilitation, Ekso has invested our knowledge and expertise in finding multiple ways for our bionics to be utilized beyond just rehab.

Ekso Bionics is, therefore, not only focused on helping those who have lost mobility due to health events but is also focused on increasing the human potential for movement in a variety of ways for able-bodied individuals. From rehabilitation to pioneering ways for workers to operate more safely and protect their bodies in the process, Ekso Bionics is revolutionizing the field of wearable robotic technology with our focus on improving humans’ natural movement potential in safe, efficient, and dynamic new ways. Keep reading for an overview of just a few of the applications that Ekso Bionics is helping to pioneer.

Robotic exoskeletons by Ekso are a technological way to improve quality of life.

While Ekso’s exoskeleton applications aren’t limited to medical settings, many physical therapists are using wearable robotic exoskeleton technology to help patients regain movement and other abilities that have been lost. Whether patients have had a spinal cord injury or were dealing with the after-effects of a stroke, EksoNR© neurorehabilitation suit was the first exoskeleton suit of its kind to be cleared by the FDA to address these mobility related issues. Beyond spinal cord injury (SCI) use and use in patients post-stroke, EksoNR is also the only robotic exoskeleton that has been cleared by the FDA to have potential benefits for those facing acquired brain injuries.

These sorts of rehabilitative features of exoskeletons and EksoNR, in particular, are major. Being supported by the Food and Drug Administration means that these devices can be freely applied to rehabilitation programs that allow wearers to work on increasing and enhancing mobility. Rehabilitation centers have continued to help patients through the use of EksoNR to work on gait training and other skills that patients may need to re-learn after a traumatic SCI or stroke.

EksoNR builds upon the progress that Ekso made with the Ekso GT to create a much more responsive exoskeleton with sensors and feedback that offer physical therapists a much more customizable approach to using the device in conjunction with physical therapy sessions. It was Ekso’s ongoing commitment to logistics and technological advancement in the field of robotics, not to mention our years of experience, that allowed us to pioneer such an exoskeleton.

Industrial exoskeletons help to prevent fatigue and improve endurance.

While Ekso’s clinical expertise has resulted in the only exoskeleton to be cleared by the FDA for brain injuries in addition to patients with spine injuries or strokes, people and businesses are also using our exoskeleton designs to help boost human performance in other ways. There are plenty of fields and occupations where the risk of injury is quite high if the proper steps are not followed. Even then, some workplace injuries are going to happen from overworking or repetitive movements. The human body can only withstand so much, even if it is in peak physical shape, driving Ekso to build an exoskeleton designed for industrial applications.

For example, Ekso sees potential for our exoskeleton models to be used in a broad array of construction and manufacturing tasks and not just in rehabilitation clinics with physical therapists. Many manufacturing lines still require a human element, and these sorts of human-powered lines run the risk of overuse injuries due to the rigorous, physical nature of the job. The EksoVest was one solution our wearable robotics company pioneered that gained traction in major companies like Ford and Boeing. The fact that these companies recognized the value offered by the EksoVest is clear, and science backs up these findings, too. Many estimates show that the injuries that come from overhead lifting, shoulder, and neck strain can be prevented by the use of the EksoVest and now, EVO, which aids in the performance of these tasks.

Not one to rest on laurels, our company launched the next generation of wearable robotics in 2020 called EVO, which builds upon the success EksoVest has had since 2016. With five years of experience and customer feedback onthe EksoVest, EVO offers increased safety and more efficient performance to construction workers, as well as those on manufacturing lines. With improved materials and a more customized fit, EVO is much more comfortable to use for an extended period of time. EVO is also more affordable for companies to adopt it to use in a variety of industrial applications, which not only helps protect workers, but also improves a business’s bottom line.

Robotics and exoskeleton technology are changing the way the world works in a variety of ways. From offering medical breakthroughs to increasing safety in physically demanding jobs, people are able to live and work better thanks to the presence of wearable exoskeletons. Throughout all of these cases, Ekso Bionics has been a pioneer, using its skills and expertise to continue pushing the world of wearable robotics forward. By leveraging technology and humans’ existing potential, we are finding ways to help the medical profession and manufacturing and construction industries evolve in previously unthinkable ways. Thanks to partnerships with world-renowned businesses and thought leaders in these fields, our company continues to find ways to help exoskeletons evolve to meet the growing demand for such applications. Since 2005, Ekso has been making significant contributions, not only to the world of robotics, but to the lives and livelihoods of real people all across the globe.

It can be one of the scariest things in the world to wake up from an illness or injury and realize that natural motor functions have been compromised. Serious spinal cord injury, strokes, or brain trauma can cause issues with paralysis or loss of function that may affect a patient’s overall quality of life. Ekso Bionics is committed to giving that sense of freedom back to patients with wearable robotic exoskeletons that can increase mobility and help patients get back on their feet in no time.

EksoNR© is a uniquely designed exoskeleton that works with the wearer to help regain natural movement, find their balance, and begin walking long distances. This leading technology is helping physical therapists and rehabilitation specialists aid patients post stroke, brain injury, and spinal cord injury in many different ways. This rehabilitation tool is helping individuals conquer their disability and get more personal freedom back. There are plenty of unique features about EksoNR exoskeleton that help patients increase their mobility in revolutionary ways.

Who benefits from EksoNR?

EksoNR is designed specifically for neurorehabilitation. In fact, EksoNR is the first medical exoskeleton that is FDA cleared to treat stroke, spinal cord injury (SCI) and acquired brain injuries (ABI). At this point in time, this is actually the only FDA cleared exoskeleton to be used as a clinical rehabilitation tool for ABI. Clinicians across the globe find that this wearable device benefits their patients while going through rehabilitation.

As patients relearn how to walk and regain their motor functions, the exoskeleton gives them support without becoming a long term crutch. The exoskeleton robot can adjust to most patients’ bodies and work in a number of different ways. Overall, the physical therapist will be able to control the interface between the rehabilitation device and the patient to help them get back on their feet sooner.

Work with the wearable robot to improve natural function.

EksoNR is revolutionizing the game when it comes to rehabilitative devices. While powered exoskeletons have been around for a while, our specific exoskeleton technology works with patients to meet them at their current stage of recovery. These aren’t assistive devices or crutches that are relied upon for an extended period of time. This wearable robot will only give the limbs the amount of support they need, allowing a patient’s muscles to relearn certain motions and get used to bearing weight and balancing. Therapists can adjust the robotic device in real-time so each weight shift starts to feel more natural and eventually the patient gains strength to take over. EksoNR, a critical rehabilitative tool, will require your patients to be active participants in their recovery.

Help with walking speed, gait, and consistency.

Every person has their own unique way of walking. Some may take wide steps while someone else’s gait is more narrow. Working with EksoNR exoskeleton, patients get to improve their personal mobility through consistency and repetition. The medical exoskeleton is designed for specific, rehabilitative use. With the help of specific algorithms and data analysis, the wearable robot will adapt to each patient’s body. A patient won’t be adapting to the exoskeleton, rather the robotic technology will work with their body specifically and adapt to them. From help at the torso, hips, knee joints, and more, this exoskeleton design makes a natural gait and longer walking distances more accessible than ever before.

Rehabilitation happens at each patient’s pace.

The beauty of EksoNR is that it helps with every step of the rehabilitation process. The same device that helps stroke victims relearn how to stand upright will also help that individual when it comes to taking their first step or walking down the hallway. EksoNR exoskeleton will be the same wearable robot that they’ll use on their future visits to the rehabilitation center. From standing and sitting to gait training, these rehabilitation robots work at each patient’s pace and help them get back to many different activities of daily living.

The personalized design is revolutionary.

When you hear about powered exoskeletons, chances are you picture bulky suits that may bring discomfort to your patients. This is not the case with Ekso Bionics’ exoskeletons. The design is revolutionary and removes any major limitations for your patients. The exoskeleton design allows patients to strap in without worrying about bearing extra weight as they work. In a way, this is a control strategy. The personalized design makes it easier for patients to forget they’re even wearing an exoskeleton. They can start to gain confidence in their own lower extremities as they gain momentum in their rehabilitation. Thanks to the design, these robotics work directly with patients to help them see improvements in their mobility more quickly than ever before.

Ekso is available worldwide.

While Ekso Bionics is based in California, the company is committed to reaching patients and physical therapists across the globe. From the United States to Australia, patients are getting the important treatment and hope that they need thanks to these wearable exoskeletons. Not only is this technology helping with the mobility of patients with chronic stroke, brain or spinal cord injury, it is mobile throughout the rehabilitation communities.

Hear some inspiring stories of how robot exoskeletons are changing lives.

Royal Rehab is the first rehabilitation center to bring this life-changing technology to Australia. This medical exoskeleton technology is helping patients from all walks of life with differing forms of paralysis gain more mobility than they ever thought possible.

One featured patient named Alex was injured in a sports accident as a teenager and was left in a quadriplegic state. Thanks to the exoskeleton, he is up and walking and regaining a sense of normalcy in his life.

Ken is another patient with an inspiring story. He was paralyzed at age 21 from an infection on his spinal cord. After decades in a wheelchair, he first started using EksoNR in his 70s. Ken is now able to walk again and has increased his walking distance and speed in just a few short weeks. This technology is shaping the lives of so many patients around the world. Imagine how it can help your rehabilitation center.

The construction and manufacturing industries are inherently hazardous and involve great deals of lifting, overhead work, and other repetitive tasks that can cause fatigue and injuries. Workplace injuries naturally cause trauma to the injured worker and the crew, and other potential effects include missed work time and a general loss of productivity on the job site. What if these situations could be entirely avoided? Ekso Bionics believes that they can be.

Ekso Bionics is the world leader in exoskeleton technology, and our assistive technology is used in a variety of industries, including neurorehabilitation with our latest models. Ekso has always believed in using our technology to enhance human capabilities and empower mobility in wearers. This began with our HULC model, which was used in military applications and special operations. The purpose was to help an industrial marine carry heavy loads over longer distances and at greater speeds than typically possible. While the support exoskeleton did technically work, it also put a strain on the user’s body, failed a functional performance validation standard, and was discontinued due to this issue.

Ever since that, Ekso has been working on other solutions for the benefit of humanity, and many of these have great industrial applications. Here are just a few of our devices that are improving the construction and manufacturing industries.

Ekso Vest

This was Ekso’s first passive exoskeleton meant for industrial settings. The durable vest would attach similar to a harness around the wearer’s waist where it would connect up through the spine and shoulder supports. This support helped workers lift heavy objects more easily, which made it a great option for overhead work, such as installing oil filters in vehicles. In fact, our partnership with Ford is what brought the Ekso Vest into the public light after workers started praising the device.

With its lightweight design, it was able to improve muscle activity, and lower metabolic costs, all without putting strain on the rest of the body thanks to symmetric lifts. While the exoskeleton didn’t grant users the strength of Iron Man, it did make repetitive lifting tasks easier, helped improve commercial transportation manufacturing, and had a variety of industrial applications. We found that the vests didn’t support a full range of motion, which could make working in certain conditions difficult. Finding this inspired us to improve and design a more ergonomic solution.

Ekso EVO

Our EVO exoskeleton is the latest evolution in industrial shoulder exoskeletons and technologies. This piece of personal protection equipment was designed in collaboration with existing customers, physical therapists, and partner feedback to provide the best in physical workload support. It currently boasts titles as the world’s most durable, naturally-tracking, and assistive exo vest.

Like the previous vest, the harness connects to the hips, so workers don’t have to worry about thigh connections or any lower body interference. Rather than a single spine support connecting to the shoulders, EVO features two support bars connecting the hips to the shoulder supports. The device features a custom fit for each worker with adjustable lift assistance and a personal height range. Large arm holes make for an easy fit and improved logistics, and minimal contact points means improved cooling.

The exoskeleton functions are backed by data from clinician testing, collected in PMID, that shows that worker capabilities are nearly endless when it comes to standing positions and overhead work thanks to superior back muscles and shoulder support. This is also thanks to a partnership with smart assist that ensured the device allowed for full strength with the full natural range of motion, meaning that a wearer’s torso, hips, thighs, and arms can move freely without resistance.

This design keeps the device as lightweight as possible for maximum comfort. Spring-loaded technology also eliminates the need for any kind of power supply or recharging. This means that there’s plenty of room to add a fall harness, further increasing safety. The rugged outer shell makes for easy care of the exoskeleton, and you can even boost its visibility with reflective tape. Workers can even control the amount of assistance for each arm separately, thanks to asymmetrical controls.

EVO is the ultimate solution to improve safety at construction sites, eliminate worker fatigue, eliminate workplace injuries, and improve productivity and worker output.

Ekso ZeroG

EVO isn’t the only way that Ekso is innovating in the construction industry. Reducing muscle fatigue thanks to overhead tasks and repetitive motions is great, but these factors aren’t the only reasons that construction workers report a high rate of injuries and pain. Oftentimes, this is due to lifting and holding heavy tools for extended periods. Now, there’s a way to get around that too. You can reduce muscle strain even more, as well as improve accuracy and workmanship with large tools, thanks to EksoZeroG.

This zero gravity arm is designed to be mounted for aerial construction jobs, such as on construction scaffolding or other aerial workstations. The spring-loaded arm is able to transfer the weight of heavy tools to its base and then into the ground, thus providing a truly weightless feeling to workers using the tool. It’s able to hold heavy tools weight up to 42 lbs., such as large drills, impact wrenches, industrial grinders, and more.

Maintenance of the unit is easy and mostly just involves keeping it clean and ensuring that moving parts are clear of debris, It currently isn’t designed to mount to a rolling cart or operator, but new innovations may remedy this in the future. It’s important to note that while the device can support loads up to 42 lbs., it only actually provides 36 lbs. of lift, so heavier tools won’t feel totally weightless.

Ekso Bionics continues researching and improving its technologies at all times. Our devices are frequently covered by IEEE, the world’s largest technical professional organization, so you can keep up with any relevant news. There’s little doubt that more innovations will be coming to the construction industry soon.